心肌瘢痕和胰岛素抵抗可预测严重缺血性心肌功能障碍患者的心血管事件：一项灌注-代谢正电子发射断层扫描研究。

Myocardial scar and insulin resistance predict cardiovascular events in severe ischaemic myocardial dysfunction: a perfusion-metabolism positron emission tomography study.

作者信息

Feola Mauro, Biggi Alberto, Chauvie Stéphane, Vado Antonello, Leonardi Giovanni, Rolfo Fabrizio, Ribichini Flavio

机构信息

Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle, Via Coppino 26, Cuneo, Italy.

出版信息

Nucl Med Commun. 2008 May;29(5):448-54. doi: 10.1097/MNM.0b013e3282f5d2bc.

DOI:10.1097/MNM.0b013e3282f5d2bc

PMID:18391729

Abstract

BACKGROUND

Clinical outcome can be predicted by metabolism-perfusion positron emission tomography (PET) in patients with severe ischaemic left ventricular dysfunction. This study determined whether the amount of viable or non-viable myocardium detected with a PET scan or clinical-functional parameters might predict cardiovascular events.

METHODS

All patients had previous myocardial infarction (>6 months previously) and left ventricular ejection fraction (LVEF) <40%. Metabolism-perfusion PET, echocardiogram and coronary angiography were provided. All subjects underwent short euglycaemic-hyperinsulinaemic clamp before the metabolism study. The dysfunctioning segment was defined as hibernating myocardium when metabolism was normal-moderately reduced with impaired perfusion (mismatch flow-metabolism). Cardiac death, hospital admission for myocardial infarction or heart failure were considered cardiovascular events.

RESULTS

Ninety-three patients (71 males, aged 64.2 years) were studied. The LVEF was 30.2+/-7.7%; 48 (51.6%) suffered an anterior myocardial infarction. Fifty-three (54.1%) subjects were treated with coronary revascularization; all had optimal medical therapy. Cardiovascular events occurred in 20/93 patients at 1-year follow-up (event group). Age (P=0.7), diabetes mellitus (P=0.6) and rate of coronary revascularization (P=0.3) were not different in the two groups. Patients who experienced cardiovascular events had larger non-viable myocardium (5.8+/-2.7 vs. 4.1+/-2.6, P=0.01), lower metabolic rate glucose (1.3+/-0.6 vs. 1.7+/-0.7 ml . kg . min, P=0.04) but similar hibernating myocardium (1.6+/-1.6 vs. 1.7+/-2, P=0.8) and baseline LVEF (28.1+/-4.8 vs. 30.7+/-8.3%, P=0.08). Having more then five non-viable segments and a metabolic rate for glucose of <0.9 mg . kg . min predicted a worse prognosis (P=0.04, log rank, 3.89; and P=0.004, log rank, 8.1, respectively).

CONCLUSION

Non-viable myocardium revealed with PET predicts mid-term clinical prognosis. Insulin resistance seems to influence the outcome.

摘要

背景

对于严重缺血性左心室功能不全患者，代谢 - 灌注正电子发射断层扫描（PET）可预测临床结局。本研究旨在确定PET扫描检测到的存活或无存活心肌量或临床功能参数是否可预测心血管事件。

方法

所有患者既往均有心肌梗死（>6个月前）且左心室射血分数（LVEF）<40%。进行了代谢 - 灌注PET、超声心动图和冠状动脉造影检查。所有受试者在代谢研究前接受了短时间的正常血糖 - 高胰岛素钳夹试验。当代谢正常 - 中度降低且灌注受损（血流 - 代谢不匹配）时，功能障碍节段被定义为冬眠心肌。心脏死亡、因心肌梗死或心力衰竭住院被视为心血管事件。

结果

研究了93例患者（71例男性，年龄64.2岁）。LVEF为30.2±7.7%；48例（51.6%）发生前壁心肌梗死。53例（54.1%）患者接受了冠状动脉血运重建治疗；所有患者均接受了最佳药物治疗。在1年随访中，93例患者中有20例发生心血管事件（事件组）。两组患者的年龄（P = 0.7）、糖尿病（P = 0.6）和冠状动脉血运重建率（P = 0.3）无差异。发生心血管事件的患者无存活心肌量更大（5.8±2.7 vs. 4.1±2.6，P = 0.01），葡萄糖代谢率更低（1.3±0.6 vs. 1.7±0.7 ml·kg·min，P = 0.04），但冬眠心肌量相似（1.6±1.6 vs. 1.7±2，P = 0.8），基线LVEF相似（28.1±4.8 vs. 30.7±8.3%，P = 0.08）。无存活节段超过5个且葡萄糖代谢率<0.9 mg·kg·min预测预后较差（分别为P = 0.04，对数秩检验，3.89；P = 0.004，对数秩检验，8.1）。