Barrington S F, Chambers J, Hallett W A, O'Doherty M J, Roxburgh J C, Nunan T O
Clinical PET Centre, Guys and St Thomas's Hospitals, London, UK.
Eur J Nucl Med Mol Imaging. 2004 Mar;31(3):355-61. doi: 10.1007/s00259-003-1369-9. Epub 2003 Nov 26.
The detection of hibernating myocardium is important because revascularisation results in improved function and prognosis in patients with hibernation but not in those with non-viable myocardium. The primary aim of this study was to compare the diagnostic accuracy of four techniques with respect to hibernation in the same study population with 6-12 months of follow-up. Twenty-five males underwent rest-stress sestamibi and delayed (>18 h) thallium scintigraphy, high-dose dobutamine stress echocardiography and nitrogen-13 ammonia/fluorine-18 fluorodeoxyglucose (NH(3)/FDG) positron emission tomography (PET). The pre-operative ejection fraction was 36.2% (+/-7.3%). Follow-up was 8.1 (+/-2.8) months. Using postoperative improvement in wall motion on echocardiography as the gold standard, 6/34 dysfunctional vascular territories were hibernating. The mean uptake of all tracers was significantly higher in hibernating than in non-viable territories ( P<0.05). Normal perfusion or mismatch on PET (FDG>NH(3) uptake) and the pattern of response to dobutamine on echocardiography were also predictive of recovery ( P<0.001 and P=0.02 respectively). Univariate logistic regression identified sestamibi, ammonia and FDG as independent predictors of hibernation. FDG-PET was, however, the only independent predictor using multivariate analysis. The nuclear techniques had high negative predictive values (NPV) of >or=95% but lower positive predictive values (PPV) of 45%-75% as compared with echocardiography, which had an NPV of 87% and a PPV of 100%. PET was the most powerful predictor of hibernation although the combination of a technique with a high PPV (echocardiography) and a high NPV (PET or sestamibi) may represent the optimal clinical choice.
冬眠心肌的检测很重要，因为血运重建可改善冬眠患者的心脏功能并使其预后更佳，但对无存活心肌的患者则不然。本研究的主要目的是在同一研究人群中比较四种技术对冬眠心肌的诊断准确性，并进行6至12个月的随访。25名男性接受了静息-负荷心肌灌注显像（静息-负荷 sestamibi和延迟（>18小时）铊闪烁显像）、大剂量多巴酚丁胺负荷超声心动图以及氮-13氨/氟-18氟脱氧葡萄糖（NH(3)/FDG）正电子发射断层扫描（PET）。术前射血分数为36.2%（±7.3%）。随访时间为8.1（±2.8）个月。以术后超声心动图上室壁运动的改善作为金标准，34个功能失调的血管区域中有6个为冬眠心肌。所有示踪剂在冬眠区域的平均摄取量显著高于无存活心肌区域（P<0.05）。PET上的正常灌注或不匹配（FDG>NH(3)摄取）以及超声心动图上对多巴酚丁胺的反应模式也可预测恢复情况（分别为P<0.001和P=0.02）。单因素逻辑回归确定 sestamibi、氨和FDG为冬眠心肌的独立预测指标。然而，多因素分析显示FDG-PET是唯一的独立预测指标。与超声心动图相比，核技术具有较高的阴性预测值（NPV），≥95%，但阳性预测值（PPV）较低，为45%-75%，而超声心动图的NPV为87%，PPV为100%。PET是冬眠心肌最有力的预测指标，尽管将具有高PPV的技术（超声心动图）和高NPV的技术（PET或sestamibi）联合使用可能是最佳的临床选择。
