Author |
이동수(Dong Soo Lee),이원우(Won Woo Lee),여정석(Jeong Seok Yeo),김석기(Seok Ki Kim),김기봉(Ki Bong Kim),정준기(June Key Chung),이명철(Myung Chul Lee), |
Abstract |
Purpose: Using rest T1-201/dipyridamole stress Tc-99m-
MIBI/24 hour T1-201 SPECT, we investigated the
predictive values of the markers of the stress-rest
reversibility (Rev), T1-201 rest perfusion (Rest), T1-
201 24 hour redistribution (Del) and Tc-99m-MIBI gated
systolic thickening (Thk) for wall motion improvement
after coronary artery bypass surgery. Materials and
Methods: In 39 patients (M:F=34:5, age 58¡¾8),
preoperative and postoperative (3 months) SPECT were
compared. 24 hour delayed SPECT was done in 16 patients
having perfusion defects at rest. Perfusion or wall
motion was scored from 0 to 3 (0:normal to 3:defect or
dyskinesia). Wall motion was abnormal in 142 segments
among 585 segments of 99 artery territories which were
surgically revascularized. Results: After bypass
surgery, ejection fraction increased from 37.8¡¾9.0%
to 45.5¡¾12.3% in 22 patients who had decreased
ejection fraction preoperatively. Wall motion improved
in 103 (72.5%) segments among 142 dysfunctional
segments. Positive predictive values (PPV) of Rev,
Rest, Del, and Thk were 83%, 76%, 43%, and 69%
respectively. Negative predictive values (NPV) of Rev,
Rest, Del, and Thk were 48%, 44%, 58%, and 21%,
respectively. Rest/gated stress/delay SPECT had PPV of
74% and NPV of 46%. Though univariate logistic
regression analysis revealed Rev (p=0.0008) and Rest
(p=0.024) as significant predictors, stepwise
multivariate test found Rev as the only good predictor
(p=0.0008). Conclusion: Among independent predictors
obtained by rest T1-201/stress gated Tc-99m-
MIBI/delayed T1-201 myocardial SPECT for wall motion
improvement after bypass surgery, stress-rest
reversibility was the single most useful predictor. |