Bax J J, Visser F C, Poldermans D, Elhendy A, Cornel J H, Boersma E, Valkema R, Van Lingen A, Fioretti P M, Visser C A
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Nucl Med. 2001 Jan;42(1):79-86.
The presence of myocardial viability is predictive of improvement in regional left ventricular (LV) function after revascularization. Studies on predicting improvement in global LV function are scarce, and the amount of viable myocardium needed for improvement in LV ejection fraction (LVEF) after revascularization is unknown. Moreover, whether the presence of viability is associated with relief of heart failure symptoms after revascularization is uncertain. Hence, the aims were to define the extent of viable myocardium needed for improvement in LVEF and to determine whether preoperative viability testing can predict improvement in heart failure symptoms.
Patients (n = 47) with ischemic cardiomyopathy (mean LVEF +/- SD, 30% +/- 6%) undergoing surgical revascularization were studied with 18F-FDG SPECT to assess viability. Regional and global function were measured before and 3-6 mo after revascularization. Heart failure symptoms were graded according to the New York Heart Association (NYHA) criteria, before and 3-6 mo after revascularization.
The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r = 0.79, P < 0.01). Receiver operating characteristic curve analysis revealed that the cutoff level of four viable segments (representing 31% of the left ventricle) yielded the highest sensitivity and specificity (86% and 92%, respectively) for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms after revascularization, with positive and negative predictive values of 76% and 71%, respectively.
The presence of substantial viability (four or more viable segments, 31% of the left ventricle) on FDG SPECT is predictive of improvement in LVEF and heart failure symptoms postoperatively.
心肌存活的存在可预测血运重建后左心室（LV）区域功能的改善。关于预测整体LV功能改善的研究较少，且血运重建后左心室射血分数（LVEF）改善所需的存活心肌量尚不清楚。此外，存活心肌的存在是否与血运重建后心力衰竭症状的缓解相关尚不确定。因此，本研究旨在确定LVEF改善所需的存活心肌范围，并确定术前存活心肌检测能否预测心力衰竭症状的改善。
对47例缺血性心肌病患者（平均LVEF±标准差，30%±6%）进行手术血运重建，采用18F-FDG SPECT评估存活心肌情况。在血运重建前及术后3 - 6个月测量区域和整体功能。根据纽约心脏协会（NYHA）标准对血运重建前及术后3 - 6个月的心力衰竭症状进行分级。
每位患者存活节段数与血运重建后LVEF的改善直接相关（r = 0.79，P < 0.01）。受试者工作特征曲线分析显示，四个存活节段（占左心室的31%）的截断水平对预测LVEF改善具有最高的敏感性和特异性（分别为86%和92%）。此外，四个或更多存活节段的存在可预测血运重建后心力衰竭症状的改善，阳性和阴性预测值分别为76%和71%。
FDG SPECT显示存在大量存活心肌（四个或更多存活节段，占左心室的31%）可预测术后LVEF和心力衰竭症状的改善。
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