应激后左心室射血分数是冠心病合并左心室功能受损患者发生主要心脏事件的独立预测因素。

Poststress left ventricular ejection fraction is an independent predictor of major cardiac events in patients with coronary artery disease and impaired left ventricular function.

作者信息

De Winter O, Van De Veire N, De Bondt P, Van De Wiele C, De Buyzere M, De Backer G, Gillebert T C, Dierckx R A, De Sutter J

机构信息

Nuclear Medicine Division, Ghent University Hospital Ghent, Belgium.

出版信息

Q J Nucl Med Mol Imaging. 2008 Sep;52(3):296-304. Epub 2007 Jan 15.

PMID:17220816

Abstract

AIM

The aim of this study was to investigate the prognostic value of myocardial perfusion and function SPECT imaging in patients with coronary artery disease (CAD) and poor left ventricular (LV) function.

METHODS

We studied 261 patients (231 men, age 66+/-10 years) with CAD and a resting LV ejection fraction (LVEF) <or= 40% assessed during myocardial gated SPECT. Perfusion defect extent was calculated using 4D-MSPECT software (Michigan University). Ischemia scoring was performed visually. Considered end points were: 1) major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction or late revascularization), 2) MACE or the need for hospitalization due to heart failure (MACE-HF) and 3) cardiac death or non-fatal myocardial infarction.

RESULTS

During a median follow-up of 31 months, 52 patients (20%) died (35 cardiac deaths), 50 (19%) developed a MACE and 69 (26%) a MACE-HF. In a clinical model, diabetes and angina status were the only predictors of MACE (chi-squared=19.3; P<0.001). By multivariate analysis, poststress LVEF (chi-squared-gain of 6.4; P=0.008) and presence of ischemia (chi-squared-gain of 5.8; P=0.018) were predictive of MACE. Similarly, diabetes mellitus (chi-squared=12.1; P<0.001), poststress LVEF (chi-squared-gain of 5.5; P=0.019) and presence of ischemia (chi-squared-gain of 4.3; P=0.044) were independent predictors of MACE-HF. Diabetes mellitus (chi-squared=17.8; P<0.001), presence of angina complaints (chi-squared-gain of 6.8; P=0.028) and poststress LVEF (chi-squared-gain of 6.3; P=0.008) were independent predictors of cardiac death or non-fatal myocardial infarction.

CONCLUSION

In patients with impaired LV function and CAD, poststress LVEF is an independent predictor of future cardiac events.

摘要

目的

本研究旨在探讨心肌灌注及功能单光子发射计算机断层扫描（SPECT）成像在冠状动脉疾病（CAD）且左心室（LV）功能较差患者中的预后价值。

方法

我们研究了261例患者（231例男性，年龄66±10岁），这些患者患有CAD且在心肌门控SPECT检查期间静息左心室射血分数（LVEF）≤40%。使用4D-MSPECT软件（密歇根大学）计算灌注缺损范围。通过视觉进行缺血评分。所考虑的终点为：1）主要不良心脏事件（MACE）（心源性死亡、非致死性心肌梗死或晚期血运重建），2）MACE或因心力衰竭住院的需求（MACE-HF），以及3）心源性死亡或非致死性心肌梗死。

结果

在中位随访31个月期间，52例患者（20%）死亡（35例心源性死亡），50例（19%）发生MACE，69例（26%）发生MACE-HF。在临床模型中，糖尿病和心绞痛状态是MACE的唯一预测因素（卡方=19.3；P<0.001）。通过多变量分析，负荷后LVEF（卡方增益为6.4；P=0.008）和缺血的存在（卡方增益为5.8；P=0.018）可预测MACE。同样，糖尿病（卡方=12.1；P<0.001）、负荷后LVEF（卡方增益为5.5；P=0.019）和缺血的存在（卡方增益为4.3；P=0.044）是MACE-HF的独立预测因素。糖尿病（卡方=17.8；P<0.001）、心绞痛症状的存在（卡方增益为6.8；P=0.028）和负荷后LVEF（卡方增益为6.3；P=0.008）是心源性死亡或非致死性心肌梗死的独立预测因素。