Jögi Jonas, Palmer John, Jonson Björn, Bajc Marika
Department of Clinical Physiology, Lund University Hospital, Lund, Sweden.
Nucl Med Commun. 2008 Aug;29(8):666-73. doi: 10.1097/MNM.0b013e328302cd26.
Left heart failure (LHF) is a common and frequently overlooked condition owing to insufficient diagnostic methods. This can potentially delay onset of treatment. Our clinical experience with ventilation/perfusion single photon emission computed tomography (V/P SPECT) indicates that perfusion shows an antigravitational distribution pattern in LHF. The aim of the study was to test the hypothesis that LHF diagnosis can be made on the basis of V/P SPECT, and to develop and perform a first evaluation of objective parameters for LHF diagnostics in terms of perfusion gradients.
This retrospective study included 247 consecutive patients with clinical suspicion of pulmonary embolism (PE), who were examined with V/P SPECT. Perfusion gradients were developed and quantified in dorso-ventral and cranio-caudal directions. Quantitative results were compared with visual interpretation of patients with normal and heart failure patterns. Patients with LHF pattern were retrospectively followed up by review of medical records to confirm or discard heart failure diagnosis at the time of V/P SPECT examination.
LHF pattern on V/P SPECT was identified in 36 patients (15%), normal ventilation/perfusion pattern was found in 67 patients (27%), and PE in 62 patients (25%). The follow-up confirmed heart failure diagnosis in 32 of the 36 cases with LHF pattern, leading to a positive predictive value of 88% for LHF diagnosis based on V/P SPECT. Dorso-ventral perfusion gradients discriminated normal from LHF patients.
In patients with suspected PE, LHF is common. Appropriate V/P SPECT pattern recognition, supported by objectively determined dorso-ventral perfusion gradients, allows the diagnosis of LHF. A positive perfusion gradient in the dorso-ventral direction should lead to consideration of heart failure as a possible explanation for the symptoms in these patients.
由于诊断方法不足，左心衰竭（LHF）是一种常见且常被忽视的病症。这可能会潜在地延迟治疗的开始。我们在通气/灌注单光子发射计算机断层扫描（V/P SPECT）方面的临床经验表明，在左心衰竭中灌注呈现反重力分布模式。本研究的目的是检验基于V/P SPECT可进行左心衰竭诊断这一假设，并根据灌注梯度开发和首次评估左心衰竭诊断的客观参数。
这项回顾性研究纳入了247例临床怀疑肺栓塞（PE）且接受V/P SPECT检查的连续患者。在背腹和头尾方向建立并量化灌注梯度。将定量结果与具有正常和心力衰竭模式患者的视觉解读进行比较。对具有左心衰竭模式的患者进行回顾性病历随访，以确认或排除V/P SPECT检查时的心力衰竭诊断。
在36例患者（15%）中识别出V/P SPECT上的左心衰竭模式，67例患者（27%）发现正常通气/灌注模式，62例患者（25%）发现肺栓塞。随访证实36例具有左心衰竭模式的病例中有32例心力衰竭诊断成立，基于V/P SPECT的左心衰竭诊断阳性预测值为88%。背腹灌注梯度可区分正常患者与左心衰竭患者。
在疑似肺栓塞的患者中，左心衰竭很常见。在客观确定的背腹灌注梯度支持下，适当的V/P SPECT模式识别可实现左心衰竭的诊断。背腹方向的正灌注梯度应促使考虑心力衰竭可能是这些患者症状的一种解释。
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