Watanabe Koji, Ohsumi Yukio, Abe Hirohiko, Hattori Masahito, Minatoguchi Shinya, Fujiwara Hisayoshi
Department of Cardiology, Hashima City Hospital, 3-246 Shinsei-cho, Hashima 501-6206, Japan.
Ann Nucl Med. 2007 Dec;21(10):563-8. doi: 10.1007/s12149-007-0070-7. Epub 2007 Dec 25.
Gated single-photon emission computed tomography (G-SPECT) was used to evaluate cardiac risk associated with noncardiac surgery and determine the benefits and indications of this technique for this type of surgery.
Patients scheduled to undergo noncardiac surgery under the supervision of anesthesiologists and subjected to preoperative cardiac evaluation using G-SPECT during the 26-month period between June 2000 and August 2002 were followed for the presence/absence of cardiac events (i.e., cardiac death, myocardial infarction, unstable angina, congestive heart failure, or fatal arrhythmia) during surgery and the postoperative period until discharged. Relationships between the occurrence of cardiac events and preoperative G-SPECT findings were evaluated.
A total of 39 patients underwent G-SPECT; 6 of the 39 exhibited abnormal ejection fraction (left ventricular ejection fraction, LVEF<or=50%) and end-systolic volume (ESV>or=50 ml). Surgery was suspended for three of these six patients and cardiac events developed in the remaining three patients. Both abnormal perfusion images (PI) and abnormal wall thickening (WT) were observed in all six patients. All six patients exhibited abnormal LVEF and/or ESV. Three patients had either abnormal PI or WT, and a cardiac event occurred in one of them. Of the five patients who experienced cardiac events during or after surgery, two exhibited a short run of ventricular tachycardia requiring a continuous administering of antiarrhythmic drugs, whereas the remaining three patients exhibited cardiac failure requiring inotropic support following surgery.
The results of this study indicate that the occurrence of perioperative cardiac events can be predicted by considering the severity of expected surgical stress and preoperative G-SPECT findings for LVEF, PI, and WT. We conclude that G-SPECT is quite useful for cardiac risk assessment in patients undergoing noncardiac surgery.
采用门控单光子发射计算机断层扫描（G-SPECT）评估非心脏手术相关的心脏风险，并确定该技术用于此类手术的益处和适应证。
对2000年6月至2002年8月这26个月期间计划在麻醉医生监督下接受非心脏手术且术前使用G-SPECT进行心脏评估的患者，随访其在手术期间及术后直至出院时心脏事件（即心源性死亡、心肌梗死、不稳定型心绞痛、充血性心力衰竭或致命性心律失常）的发生情况。评估心脏事件的发生与术前G-SPECT检查结果之间的关系。
共有39例患者接受了G-SPECT检查；39例中的6例表现为射血分数异常（左心室射血分数，LVEF≤50%）和收缩末期容积异常（ESV≥50 ml）。这6例患者中有3例手术暂停，其余3例发生了心脏事件。所有6例患者均观察到灌注图像（PI）异常和室壁增厚（WT）异常。所有6例患者均表现出LVEF和/或ESV异常。3例患者仅有PI或WT异常，其中1例发生了心脏事件。在手术期间或术后发生心脏事件的5例患者中，2例出现短阵室性心动过速，需要持续给予抗心律失常药物，而其余3例患者术后出现心力衰竭，需要给予正性肌力支持。
本研究结果表明，通过考虑预期手术应激的严重程度以及术前G-SPECT检查的LVEF、PI和WT结果，可以预测围手术期心脏事件的发生。我们得出结论，G-SPECT对于接受非心脏手术患者的心脏风险评估非常有用。
