Hayes Sean W, De Lorenzo Andrea, Hachamovitch Rory, Dhar Sanjay C, Hsu Patrick, Cohen Ishac, Friedman John D, Kang Xingping, Berman Daniel S
Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Nucl Med. 2003 Oct;44(10):1633-40.
Although acquisition of (99m)Tc-sestamibi myocardial perfusion SPECT (MPS) with the patient in the prone position is commonly used to minimize attenuation artifacts, the impact of combined prone and supine imaging on the prognostic evaluation of coronary artery disease (CAD) has not been determined. The prognostic implications of MPS obtained in both prone and supine positions in patients with perfusion defects on supine MPS were evaluated.
We studied 3,834 patients who were monitored for 24.2 +/- 6.0 mo after rest (201)Tl/stress (99m)Tc-sestamibi MPS acquired during 1994-1995, when prone acquisition was performed only in patients with inferior wall perfusion defects that might represent attenuation or motion artifact.
During follow-up, there were 132 hard events (cardiac death or myocardial infarction) and 375 total events (hard events or late myocardial revascularization). Overall, patients who underwent prone and supine acquisitions had similar characteristics to those who underwent supine-only imaging, with the exception of being more commonly male. In multivariable analysis, there were similar independent predictors for hard events and total events; the type of acquisition (prone and supine or supine-only) was not a significant predictor of either of these outcome events. After risk adjustment, the predicted event rates were nearly identical for patients undergoing prone and supine compared with supine-only studies. Both observed and predicted hard event rates of patients with normal prone and supine versus supine-only imaging were very low (observed, 0.7%/y and 0.5%/y, respectively; predicted, 1.5% over 24 mo for both). There was no reduction in the higher rates of events associated with abnormal scan results with the combination of prone and supine imaging.
Patients with inferior wall defects on supine MPS that are not present on prone MPS have a low risk of subsequent cardiac events, similar to that of patients with normal supine-only studies.
尽管让患者处于俯卧位进行（99m）锝-司他比心肌灌注单光子发射计算机断层显像（MPS）常用于将衰减伪影降至最低，但联合俯卧位和仰卧位成像对冠状动脉疾病（CAD）预后评估的影响尚未确定。对仰卧位MPS有灌注缺损的患者在俯卧位和仰卧位获得的MPS的预后意义进行了评估。
我们研究了3834例患者，这些患者在1994年至1995年期间进行静息（201）铊/负荷（99m）锝-司他比MPS检查后接受了24.2±6.0个月的监测，当时仅对下壁灌注缺损可能代表衰减或运动伪影的患者进行俯卧位采集。
在随访期间，发生了132例严重事件（心源性死亡或心肌梗死）和375例总事件（严重事件或晚期心肌血运重建）。总体而言，接受俯卧位和仰卧位采集的患者与仅接受仰卧位成像的患者具有相似的特征，只是男性更为常见。在多变量分析中，严重事件和总事件有相似的独立预测因素；采集类型（俯卧位和仰卧位或仅仰卧位）不是这些结局事件中任何一个的显著预测因素。在风险调整后，与仅进行仰卧位研究相比，接受俯卧位和仰卧位检查的患者的预测事件发生率几乎相同。与仅进行仰卧位成像相比，俯卧位和仰卧位均正常的患者观察到的和预测的严重事件发生率都非常低（观察到的分别为0.7%/年和0.5%/年；预测的在24个月内均为1.5%）。联合俯卧位和仰卧位成像并没有降低与异常扫描结果相关的较高事件发生率。
仰卧位MPS显示下壁缺损而俯卧位MPS未显示的患者随后发生心脏事件的风险较低，与仅进行仰卧位检查正常的患者相似。
