Elhendy Abdou, van Domburg Ron T, Vantrimpont Pascal, Poldermans Don, Bax Jeroen J, van Gelder Teun, Baan Carla C, Schinkel A, Roelandt Jos R T C, Balk Aggie H M M
Heart Transplant Unit, Thoraxcenter, Rotterdam, The Netherlands.
Am J Cardiol. 2002 Apr 15;89(8):964-8. doi: 10.1016/s0002-9149(02)02247-6.
Cardiac allograft vasculopathy is a major cause of mortality in heart transplant recipients. The aim of this study was to assess the prognostic value of stress myocardial perfusion imaging in heart transplant recipients. We studied 166 patients (age 54 +/- 10 years, 140 men) by symptom-limited bicycle exercise or dobutamine (up to 40 microg/kg/min) stress myocardial perfusion imaging 7.4 +/- 2.5 years after heart transplantation. An intravenous dose of 370 MBq of technetium-99m tetrofosmin was injected at peak stress and 24 hours after the stress test. An abnormal test was defined as reversible or fixed perfusion defects. Perfusion abnormalities were detected in 55 patients (33%). During a median follow-up of 2.5 years, 54 deaths (33%) occurred, 16 of which were due to cardiac causes. The incidence of perfusion abnormalities was higher in patients with subsequent cardiac death than in patients without subsequent cardiac death (69% vs 29%, p = 0.01). In an incremental multivariate Cox analysis, cardiac death was not predicted by age, gender, duration of transplantation, number of rejection episodes, or cytomegalovirus infection. In the next step, stress test parameters were added. The peak rate-pressure product was the only significant predictor at this step (risk ratio 0.84, 95% confidence interval 0.73 to 0.97, chi-square 7.7, p = 0.006). In the final step, the presence of abnormal myocardial perfusion was an independent predictor of cardiac death (risk ratio 3.5, 95% confidence interval 1.6 to 11.7, chi-square 4.7, incremental to clinical and stress test variables, p = 0.01). It is concluded that stress myocardial perfusion imaging with technetium-99m tetrofosmin single-photon emission computed tomography provides incremental data for the prediction of cardiac death in heart transplant recipients.
心脏移植血管病变是心脏移植受者死亡的主要原因。本研究的目的是评估负荷心肌灌注成像对心脏移植受者的预后价值。我们对166例患者（年龄54±10岁，男性140例）进行了研究，在心脏移植后7.4±2.5年通过症状限制性踏车运动或多巴酚丁胺（最大剂量40μg/kg/min）负荷心肌灌注成像进行检查。在负荷高峰和负荷试验后24小时静脉注射370MBq的锝-99m替曲膦。异常检查定义为可逆或固定灌注缺损。55例患者（33%）检测到灌注异常。在中位随访2.5年期间，发生54例死亡（33%），其中16例死于心脏原因。后续发生心脏死亡的患者中灌注异常的发生率高于未发生后续心脏死亡的患者（69%对29%，p=0.01）。在逐步多因素Cox分析中，年龄、性别、移植时间、排斥反应次数或巨细胞病毒感染不能预测心脏死亡。下一步，加入负荷试验参数。在此步骤中，峰值心率血压乘积是唯一的显著预测因素（风险比0.84，95%置信区间0.73至0.97，卡方值7.7，p=0.006）。在最后一步，心肌灌注异常的存在是心脏死亡的独立预测因素（风险比3.5，95%置信区间1.6至11.7，卡方值4.7，相对于临床和负荷试验变量增加，p=0.01）。结论是以锝-99m替曲膦单光子发射计算机断层扫描进行的负荷心肌灌注成像为预测心脏移植受者心脏死亡提供了补充数据。
