多巴酚丁胺负荷99mTc-司他米比SPECT的长期预后价值：单中心8年随访经验

Long-term prognostic value of dobutamine stress 99mTc-sestamibi SPECT: single-center experience with 8-year follow-up.

作者信息

Schinkel Arend F L, Elhendy Abdou, Van Domburg Ron T, Bax Jeroen J, Valkema Roelf, Roelandt Jos R T C, Poldermans Don

机构信息

Department of Cardiology, Erasmus Medical Center Rotterdam, Dr Molewaterplein 40, Thoraxcenter Rm Ba 300, 3015 GD Rotterdam, the Netherlands.

出版信息

Radiology. 2002 Dec;225(3):701-6. doi: 10.1148/radiol.2253020053.

DOI:10.1148/radiol.2253020053

PMID:12461248

Abstract

PURPOSE

To determine the long-term prognostic value of dobutamine stress technetium 99m (99mTc)-labeled sestamibi single photon emission computed tomography (SPECT) in patients with limited exercise capacity.

MATERIALS AND METHODS

Clinical data and SPECT results were analyzed in 531 consecutive patients. Follow-up was successful in 528 (99.4%) patients; 55 underwent early revascularization and were excluded. Normal or abnormal findings were considered in the absence or presence of fixed and/or reversible perfusion defects. A summed stress score was calculated to estimate the extent and severity of perfusion defects. Univariate and multivariate Cox proportional hazards regression models were used to identify independent predictors of late cardiac events. The incremental value of myocardial perfusion scintigraphy over clinical variables in predicting events was determined according to two models. The probability of survival was calculated by using the Kaplan-Meier method.

RESULTS

Findings were abnormal in 312 patients. During 8.0 years +/- 1.5 of follow-up (range, 4.5-10.6 years), cardiac death occurred in 67 patients (total deaths, 165); nonfatal myocardial infarction, in 34; and late revascularization, in 49. The annual rates for cardiac death, cardiac death or infarction, and all events were 0.9%, 1.2%, and 1.5%, respectively, after normal findings and 2.7%, 3.4%, and 4.4%, respectively, after abnormal findings (P <.05). In a multivariable Cox proportional hazards model, not only an abnormal finding but also the summed stress score provided incremental prognostic information in addition to clinical data. The hazard ratio for cardiac death was 1.09 (95% CI: 1.01, 1.18) per 1-unit increment of the summed stress score.

CONCLUSION

The incremental prognostic value of dobutamine stress 99mTc-sestamibi SPECT over clinical data was maintained over an 8-year follow-up in patients with limited exercise capacity.

摘要

目的

确定多巴酚丁胺负荷99m锝（99mTc）标记的甲氧基异丁基异腈单光子发射计算机断层扫描（SPECT）对运动能力受限患者的长期预后价值。

材料与方法

分析531例连续患者的临床资料和SPECT结果。528例（99.4%）患者随访成功；55例接受早期血运重建，予以排除。根据有无固定和/或可逆性灌注缺损判断结果正常或异常。计算总负荷评分以评估灌注缺损的范围和严重程度。采用单因素和多因素Cox比例风险回归模型确定晚期心脏事件的独立预测因素。根据两种模型确定心肌灌注显像在预测事件方面相对于临床变量的增量价值。采用Kaplan-Meier法计算生存率。

结果

312例患者结果异常。在8.0年±1.5年（范围4.5 - 10.6年）的随访期间，67例患者发生心源性死亡（总死亡165例）；34例发生非致命性心肌梗死；49例进行晚期血运重建。结果正常组心源性死亡、心源性死亡或心肌梗死以及所有事件的年发生率分别为0.9%、1.2%和1.5%，结果异常组分别为2.7%、3.4%和4.4%（P <.05）。在多因素Cox比例风险模型中，除临床资料外，不仅结果异常，而且总负荷评分也提供了增量预后信息。总负荷评分每增加1个单位，心源性死亡的风险比为1.09（95%CI：1.01, 1.18）。