肾功能对心脏碘-123间碘苄胍闪烁显像预后价值的重要性。

Importance of renal function on prognostic value of cardiac iodine-123 metaiodobenzylguanidine scintigraphy.

作者信息

Furuhashi Tatsuhiko, Moroi Masao

机构信息

Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan.

出版信息

Ann Nucl Med. 2007 Jan;21(1):57-63. doi: 10.1007/BF03034000.

DOI:10.1007/BF03034000

PMID:17373337

Abstract

OBJECTIVE

Cardiac iodine-123 metaiodobenzylguanidine (MIBG) can be used to evaluate cardiac sympathetic nerve function and is useful for assessing the prognosis of patients with heart disease. Renal impairment in heart failure patients has been recognized as an independent risk factor for morbidity and mortality, and has been observed as abnormal uptake and washout of cardiac MIBG imaging. The purpose of this study was to evaluate the prognostic value of cardiac MIBG imaging in heart disease patients with a glomerular filtration rate (GFR) either > or = 60 ml/min/1.73 m2 or < 60 ml/min/1.73 m2.

METHODS

Heart disease patients (n: 135, male/female: 87/48, mean age: 63 years, coronary artery disease/dilated cardiomyopathy/myocarditis: 41/62/32, mean left ventricular ejection fraction: 51%, GFR > or = 60 ml/min/1.73 m2/ GFR < 60 ml/min/1.73 m2: 103/32) underwent cardiac MIBG imaging and were followed-up for 2.7 years. GFR was calculated by the Modification of Diet in Renal Disease (MDRD) equation. Cardiac MIBG imaging was obtained 15 min and 4 h after isotope injection. The parameters analyzed for cardiac MIBG imaging were the heart-to-mediastinum ratio (H/M) on the delayed planar image and the cardiac washout rate.

RESULTS

Cardiac death was observed in 9 of 103 patients (9%) with a GFR > or = 60 ml/min/1.73 m2 and in 6 of 32 patients (19%) with a GFR < 60 ml/min/1.73 m2. The mortality ratio tended to be higher in patients with a GFR < 60 ml/min/1.73 m2 than in patients with a GFR > or = 60 ml/min/1.73 m2 (p = 0.10 with Kaplan-Meier survival curves). In patients with a GFR > or = 60 ml/min/1.73 m2, Cox regression analysis showed that a delayed H/M < 146% was the most powerful predictor for cardiac death (Hazard ratio: 6.9, p = 0.014). However, in patients with a GFR < 60 ml/min/1.73 m2, the utility of cardiac MIBG imaging could not be proved.

CONCLUSIONS

A delayed H/M is a powerful predictor of cardiac death if the GFR is 60 ml/min/1.73 m2 or more.

摘要

目的

心脏碘-123间碘苄胍（MIBG）可用于评估心脏交感神经功能，有助于评估心脏病患者的预后。心力衰竭患者的肾功能损害已被视为发病和死亡的独立危险因素，并且在心脏MIBG成像中观察到摄取和洗脱异常。本研究的目的是评估肾小球滤过率（GFR）≥60 ml/（min·1.73 m²）或＜60 ml/（min·1.73 m²）的心脏病患者心脏MIBG成像的预后价值。

方法

135例心脏病患者（男/女：87/48，平均年龄：63岁，冠状动脉疾病/扩张型心肌病/心肌炎：41/62/32，平均左心室射血分数：51%，GFR≥60 ml/（min·1.73 m²）/GFR＜60 ml/（min·1.73 m²）：103/32）接受心脏MIBG成像，并随访2.7年。GFR通过肾脏病饮食改良（MDRD）方程计算。在同位素注射后15分钟和4小时获得心脏MIBG成像。分析心脏MIBG成像的参数为延迟平面图像上的心脏与纵隔比值（H/M）和心脏洗脱率。

结果

GFR≥60 ml/（min·1.73 m²）的103例患者中有9例（9%）发生心源性死亡，GFR＜60 ml/（min·1.73 m²）的32例患者中有6例（19%）发生心源性死亡。GFR＜60 ml/（min·1.73 m²）的患者死亡率倾向于高于GFR≥60 ml/（min·1.73 m²）的患者（Kaplan-Meier生存曲线，p = 0.10）。在GFR≥60 ml/（min·1.73 m²）的患者中，Cox回归分析显示延迟H/M＜146%是心源性死亡的最强预测因素（风险比：6.9，p = 0.014）。然而，在GFR＜60 ml/（min·1.73 m²）的患者中，无法证明心脏MIBG成像的效用。