Læknablaðið - 15.02.1984, Blaðsíða 35

LÆK.NABLAÐIÐ
71
rannsókn, ef ekki var um hjartasjúkdóm að
ræða.
í töflu IV er borin saman greining á
hjartadrepi með hefðbundnum hætti og grein-
ing með hjartaskönnun. Spágildi jákvæðra
skanna reyndist 89 % par sem um rétta
greiningu á hjartaskanni var að ræða í 58
tilvikum af 65. Spágildi neikvæðra skanna
reyndist 68% í pessari rannsókn par sem 17
hjartaskönn voru tesin falskjákvætt (37:54).
í töflu V er staðsetning hjartadreps á
hartariti borin saman við staðsetningu á hjarta-
skanni. Rannsóknunum tveimur ber allvel
saman við staðsetningu á framveggsdrepi, eða
í 20 tilvikum af 25, 80 %. í fjórum af peim
fimm tilvikum, par sem rannsóknunum ber
ekki saman, reyndist um bakveggshjartadrep
að ræða. Hins vegar bar rannsóknunum ein-
ungis saman í 69 % tilvika, eða 11 af 16, pegar
Table I. Study group.
N Sex M F Mean Age
Acute myocardial
infarction 75 57 18 63.8
Transmural .. 45 (32-91)
Subendocardial .. 30
Other heart disease 30 23 7 69.5
Angina pectoris .. 24 (44-78)
Arrhythmia 3
LBBB 2
Aortic stenosis 1
Other diseases 5 3 2 69.0
Pneumonia .. 3 (43-93)
Chronic gastritis .... 2
Healthy controls 11 9 2 25.0
(22-30)
Table II. Sensitivity of infarct scintigraphy. The
infarctions are grouped as transmurai, subendocar-
dial and all infarcts. The groups are divided accor-
ding to the timing of the investigation after the
onset of symptoms.
< 5 days from onset of sympt. >5 days from onset of sympt. < 10 days from onset of sympt.
Transmural infarcts 28/34 82 % 7/11 64 o/o 35/45 78 %
Subendocardial infarcts 17/21 81 % 5/9 56 o/o 22/30 73 %
All infarcts 45/55 82 % 12/20 60 % 57/75 76 %
um undirveggsdrep var að ræða. Skýringin er
sú, að undirveggshjartadrep voru oftast van-
greind, eða í 11 tilvikum af 18.
Table III. Specificity of infarct scintigraphy. The
scintigraphic results are shown as either negative or
positive. The numbers within parentheses show two
patients with an uncertain ctinical diagnosis who
probably had myocardial infarction.
Total groups without infarction Scintigraphy Neg. Pos.
Healthy ...-. .... ii ii
Angina pectoris .... .... 23(1) 17 6(1)
LBBB .... 1(1) 1 (1)
Arrhythmia .... 3 2 1
Aortic stenosis 1 1
Other diseases .... 5 5
44 (2) 37 7(2)
Specificity = 37/44 = 84 %
Table IV. Concordance between conventional diag-
nosis of infarction and scintigraphy for all infarc-
tions. The left column shows positive scintigraphy
and the right negative. The upper line shows those
patients who had acute infarction according to
conventional criteria, but the lower line shows those
who did not have infarction. The two patients
shown within parentheses probably had infarction
although they did not fuifii all criteria. The calculati-
on of predictive value is shown.
Scintigraphy + — Total
AMI
4- 58 17 75
- 7(2) 37 44 (2)
Total 65(2) 54 119(2)
Predictive value of pos.. scintigraphy = 58/65 = 89 %
Predictive value of neg. scintigraphy = 37/54 = 68 %
Table V. Comparison of location of infarction by
ECG versus scintigram. To the left is the ECG
location and above the location by scintigram. The
diffuse and the false negatives are shown separately.
The numbers in parentheses denote subendocardial
infarction and those that could not be specified by
ECG as either transmural or subendocardial.
Location by ECG Ant Inf Post Dif- fuse False- neg Total
Ant .... 15(5) i 2(2) (5) 2(2) 20(14)
Inf 5 8(3) 2(1) 8(3) 23(7)
Post ... 1 1 (1) 2(1)
Uncert . (1) (2) (2) (1) (2) 0(8)
Concordance rate for anterior AMI 20/25 = 80 %
Concordance rate for inferior AMI 11/16 = 69 %