Sharir Tali, Kang Xingping, Germano Guido, Bax Jeroen J, Shaw Leslee J, Gransar Heidi, Cohen Ishac, Hayes Sean W, Friedman John D, Berman Daniel S
Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048, USA.
J Nucl Cardiol. 2006 Jul;13(4):495-506. doi: 10.1016/j.nuclcard.2006.03.019.
Whether there are gender differences in the prognostic application of gated myocardial perfusion single photon emission computed tomography (SPECT) has not been assessed.
Gender-specific normal limits of poststress volume and ejection fraction (EF) were obtained in 597 women and 824 men with a low likelihood of coronary artery disease and normal perfusion and were applied in a prognostic evaluation of 6713 patients (2735 women and 3978 men). Patients underwent rest thallium-201/stress technetium-99m sestamibi gated myocardial perfusion SPECT and were followed up for 35 +/- 14 months. The upper limit of the end-systolic volume (ESV) index was 27 mL/m2 in women and 39 mL/m2 in men, and the upper limit of the end-diastolic volume index was 60 mL/m2 in women and 75 mL/m2 in men. The lower limit of the EF was 51% in women and 43% in men. Gated SPECT variables provided incremental prognostic information in both genders. Women with severe ischemia and an EF lower than 51% or an ESV index greater than 27 mL/m2 were at very high risk of cardiac death or myocardial infarction (3-year event rates of 39.8% and 35.1%, respectively), whereas women with severe ischemia but an EF of 51% or greater or an ESV index of 27 mL/m2 or less were at intermediate or high risk (3-year event rates of 10.8% and 15.2%, respectively).
Poststress EF and ESV index by gated myocardial perfusion SPECT provide comparable incremental prognostic information over perfusion in women and men. After separate criteria for abnormal EF and ESV index in women are used, the combination of severe ischemia and abnormal EF or ESV index identifies women at very high risk of cardiac events.
门控心肌灌注单光子发射计算机断层扫描（SPECT）在预后应用中是否存在性别差异尚未得到评估。
在597名冠状动脉疾病可能性低且灌注正常的女性和824名男性中获得了应激后容积和射血分数（EF）的性别特异性正常范围，并将其应用于6713例患者（2735名女性和3978名男性）的预后评估。患者接受静息铊-201/应激锝-99m甲氧基异丁基异腈门控心肌灌注SPECT检查，并随访35±14个月。女性的收缩末期容积（ESV）指数上限为27 mL/m²，男性为39 mL/m²；女性的舒张末期容积指数上限为60 mL/m²，男性为75 mL/m²。女性的EF下限为51%，男性为43%。门控SPECT变量在两性中均提供了额外的预后信息。严重缺血且EF低于51%或ESV指数大于27 mL/m²的女性发生心脏死亡或心肌梗死的风险非常高（3年事件发生率分别为39.8%和35.1%），而严重缺血但EF为51%或更高或ESV指数为27 mL/m²或更低的女性处于中危或高危（3年事件发生率分别为10.8%和15.2%）。
门控心肌灌注SPECT的应激后EF和ESV指数在女性和男性中提供了与灌注相当的额外预后信息。在使用女性EF和ESV指数异常的单独标准后，严重缺血与异常EF或ESV指数的组合可识别出发生心脏事件风险非常高的女性。
