RÉSUMÉ
ObjectiveTo evaluate the value of adenosine-stress myocardial perfusion imaging (MPI)in post-operation follow-up after the percutaneous coronary intervention(PCI) in the elderly.MethodsThere were patients (53 cases) underwent adenosine-stress MPI prior to and 6 months after PCI. Major adverse cardiovascular events (MACE) were followed. Left ventricular ejection fraction (LVEF) was analyzed in 40 cases. The image of the left ventricular myocardium was divided into 16 segments to calculate total defect score using a 4-grade assessment.Myocardial scintigrams were evaluated by calculating the summed adenosine-stress score and coronary angiography assessed by calculating the summed score of coronary artery stenosis.Results There was a significant correlation between the scores of coronary artery stenosis and adenosine-stress MPI scores (r=0.675,P＜0.01). Adenosine-stress MPI scores were obviously lower after PCI than before(2.2± 2.3 vs. 4.5±1.9,t= 7.348, P＜0.01); LVEF was significantly greater after PCI than pre-operation[(58.3±10.5 ) ％ vs. (53.8 ± 10.3) ％, t = 3.497, P＜0.01] and the effective rate for myocardial perfusion were 86.84 ％. Conclusions Adenosine stress MPI is a good noninvasive diagnostic method with high accuracy and plays an important role for evaluating recovery of myocardial perfusion and left ventricle function in the elderly patients after PCI.
RÉSUMÉ
Objective To analyze the diagnostic accuracy and safety of adenosine stress 99mTc-MIBI myocardial perfusion single photon emission computed tomography(SPECT)for assessing coronary artery disease(CAD)in the elderly. Methods 63 elderly patients(≥65 years old)without myocardial infarction were enrolled in the research.They were admitted into hospital because of suspected CAD or suffering from acute coronary syndrome.Adenosine was infused intravenously at a rate of 140μg·kg-1·min-1 for 6 minutes.During the period.all patients were given electrocardiogram monitor and blood pressure detection,the uncomfortable symptoms were recorded.At the end of 3 minutes of adenosine infusion,925MBq of 99mTc-MIBI was injected intravenously.Then adenosine stress SPECT myocardial imaging acquisition was obtained.If the results were abnormal.the rest SPECT myocardial imaging would be performed next day.All patients underwentcoronary angiography(CAG)within 1 week before or after SPECT. Results In the 53 CAD patients diagnosed by CAG,there were 51 cases with positive adenosine 99mTC-MIBI myocardial perfusion SPECT.In 10 cases with normal CAG there were 7 cases with negative adenosine myocardial imaging.The results showed the sensitivity,specificity and accuracy of adenosine stress SPECT in detection of CAD in comparison with CAG were 96.2%,70.0%,92.1%respectively.The results of CAG also showed that 74 coronary arteries had been affected(defined as≥50%coronary vessel lumen reduction).There were 44 cases with affection in left anterior descending(LAD),18 eases in left circumflex(LCX)and 25 cases in right coronary artery(RCA).Correspondingly,there were 42 patients with lowering myocardial perfusion in anterior wall territory,10 patients in lateral wall territory and 21 patients in inferior wall territory.The sensitivity of adenosine 99mTc-MIBI myocardial perfusion SPECT for diagnosing LAD lesion was 95.5%,which was higher than for the other 2 coronary arteries,but the specificity for detecting LCX lesion was 100%.The adverse effects during the adenosine stress test were found in 50%patients,no serious events occurred.Conclusions Adenosine stress 99mTc-MIBI myocardial perfusion SPECT is a good noninvasive method with high diagnostic accuracy and safety in detection of CAD in the elderly,especially.highly accurate for detection and localization of significant CA D.