ABSTRACT
Objective@#To investigate the incremental value of coronary flow reserve (CFR) assessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD).@*Methods@#Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+ CFR in the diagnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analysis.@*Results@#Of 132 patients, 61 (46.2%) were CAD with stenosis of at least 75% in one vessel (47.5%, 29/61), two vessels (34.4%, 21/61), or three vessels (18.0%, 11/61). A total of 104 (26.3%) vessels with stenosis of at least 75%, 25 (6.3%) vessels with stenosis of 65%-74%, and 30 (7.6%) vessels with stenosis of 50%-64% were found in 396 vessels. For detecting coronary stenosis of at least 75%, the sensitivity and accuracy of MPI on per-patient analysis were 86.89%(53/61) and 68.94%(91/132), which increased to 96.72%(59/61; χ2=3.921, P<0.05) and 87.88%(116/132; χ2=13.984, P<0.01) by MPI+ CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12%(75/104) and 77.53%(307/396) and increased to 96.15%(100/104; χ2=22.511, P<0.01) and 85.10%(337/396; χ2=7.479, P<0.05) by MPI+ CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72.41%(21/29), 42.86%(9/21), and 5/11 and were improved to 93.10%(27/29; χ2=4.350, P=0.037), 90.48%(19/21; χ2=10.714, P=0.001), and 11/11 (P=0.012) by MPI+ CFR. For coronary with stenosis of 65%-74%, the sensitivity of MPI was 24.00%(6/25) and was improved to 64.00%(16/25; χ2=8.117, P=0.004) by MPI+ CFR. For coronary with stenosis of 50%-64%, the sensitivity of MPI was 40.00%(12/30) and was improved to 76.67%(23/30; χ2=8.297, P=0.004) by MPI+ CFR.@*Conclusion@#As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
ABSTRACT
Objective To investigate the incremental value of coronary flow reserve ( CFR) as-sessed by cadmium zinc telluride(CZT)-SPECT as an adjunct to myocardial perfusion imaging (MPI) in the diagnosis of coronary artery disease (CAD). Methods Data of 132 patients (89 males, 43 females; 40-81 years) with or suspected with CAD who successfully underwent rest and stress MPI and CFR from November 2017 to October 2018 in Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Based on coronary angiography (CAG) as the " gold standard" , the value of MPI and MPI+CFR in the di-agnosis of CAD was evaluated and compared. χ2 test or Fisher exact probability test was used for data analy-sis. Results Of 132 patients, 61 (46.2％) were CAD with stenosis of at least 75％ in one vessel (47.5％, 29/ 61), two vessels (34.4％, 21/ 61), or three vessels (18.0％, 11/ 61). A total of 104 (26.3％) vessels with stenosis of at least 75％, 25 (6.3％) vessels with stenosis of 65％-74％, and 30 (7.6％) vessels with stenosis of 50％-64％ were found in 396 vessels. For detecting coronary stenosis of at least 75％, the sensi-tivity and accuracy of MPI on per-patient analysis were 86.89％(53/ 61) and 68.94％(91/ 132), which in-creased to 96.72％(59/ 61; χ2 = 3.921, P<0.05) and 87.88％(116/ 132; χ2 = 13.984, P<0.01) by MPI+CFR. On per-vessel analysis, the sensitivity and accuracy of MPI were 72.12％ (75/ 104) and 77. 53％(307/ 396) and increased to 96.15％(100/ 104; χ2 = 22. 511, P<0.01) and 85.10％(337/ 396; χ2 = 7.479, P<0.05) by MPI+CFR. The sensitivity of MPI for predicting one, two, and three vessels disease were 72. 41％(21/ 29), 42.86％ (9/ 21), and 5/ 11 and were improved to 93.10％ (27/ 29; χ2 = 4.350, P =0. 037), 90.48％(19/ 21; χ2 = 10.714, P = 0.001), and 11/ 11 (P = 0.012) by MPI+CFR. For coronary with stenosis of 65％-74％, the sensitivity of MPI was 24. 00％(6/ 25) and was improved to 64.00％(16/25; χ2 = 8.117, P= 0.004) by MPI+CFR. For coronary with stenosis of 50％-64％, the sensitivity of MPI was 40.00％(12/ 30) and was improved to 76.67％(23/ 30; χ2 = 8.297, P= 0.004) by MPI+CFR. Conclu-sion As an adjunct to MPI, CFR can significantly improve the sensitivity and accuracy in the diagnosis of CAD, particularly for patients with mild stenosis and multivessel CAD.
ABSTRACT
Objective To explore the alteration of brain pain functional areas in patients with functional dyspepsia (FD) irritable bowel syndrome (IBS) overlap by rectal balloon volume stimulation and magnetic resonance imaging (MRI) and the differences with IBS alone patients and healthy individuals were compared.Methods A total of 11 IBS alone patients,16 IBS overlapped with FD patients (IBS-FD) and 10 healthy controls were recruited.Sensory thresholds and visual analogue scale (VAS) were recorded during the rectal balloon air injection process. The changes of brain activated areas were analyzed by functional MRI (fMRI) when the rectum was stimulated at the volume of 50,100 and 150 ml.The data were analyzed by least significant difference (LSD) test.Results Under rectal volumetric stimulation,the sensory thresholds of IBS-FD group and IBS alone group were (53.14 ± 16.05) ml and (59.20 ± 20.55) ml and the difference was not statistically significant (LSD test,P＞0.05).There was no significant difference in VAS score between IBS alone group and IBS-FD group (LSD test,P＞0.05).Rectal stimulated under different volume,the results of fMRI indicated the activation of anterior cingulated cortex, dorsolateral prefrontal cortex,postporietal cortex,thalamus and insular cortex in both IBS alone group and IBS-FD group.And there was no significant difference in activated areas and intensity between IBS alone group and IBS-FD group (LSD test,P＞0.05).Conclusions There was no significant difference in activations of brain areas between IBS alone and IBS-FD patients under rectal volumetric stimulation. Under rectal volumetric stimulation,although symptoms overlapped,there was no evidence of the overlap of braingut axis and visceral hypersensitivity between IBS alone and IBS-FD.