Santana Cesar A, Faber Tracy L, Soler-Peter Marina, Sanyal Rupan, Esteves Fabio P, Ornelas Mario, Folks Russell D, Verdes Liudmila, Santana Leonela F, Candell-Riera Jaume, Garcia Ernest V
Emory University School of Medicine, Department of Radiology, Atlanta, Georgia 30322, USA.
Nucl Med Commun. 2008 Nov;29(11):970-81. doi: 10.1097/MNM.0b013e3283073b60.
This study was performed to determine the prognostic performance of quantitative PET tools in the stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment.
We applied four different quantitative tools to 104 consecutive patients with coronary artery disease and previous myocardial infarction who had undergone rest Rb/gated F-fluorodeoxyglucose (FDG) PET, to assess myocardial viability for potential revascularization. One of these tools was based on the FDG study alone and the other three tools assessed the extent of match/mismatch defects using FDG in comparison with a perfusion reference database. The four quantitative tools used in this research to define viability were (i) FDG alone, which calculates the percentage of left ventricular myocardium (LVM) that is above the 50% of the maximum LVM FDG counts, (ii) low flow match/mismatch, which determines the area with a 5% increase in normalized FDG counts in relation to defined resting perfusion defects as compared with a reference database, (iii) all regions match/mismatch, which computes the area with a 10% increase in normalized FDG counts in relation to the left ventricle resting perfusion distribution, and (iv) percentage max FDG match/mismatch, which defines the area with FDG uptake greater than 60% of the maximum LVM FDG counts within defined perfusion defects as determined by the reference database. The primary endpoint for this analysis was cardiac death.
During the follow-up period (22+/-14 months), 19 patients (18%) died; in 17 of these the cause of death was cardiac. Using univariate analysis, none of the methods were predictive of cardiac death. Receiver operating characteristic analysis defined the optimal thresholds for the extent of myocardial viability for the four tools in the prediction of cardiac death: FDG alone=20%, low flow match/mismatch=15%, all regions match/mismatch=35%, and percentage max FDG match/mismatch=20%. A censored survival analysis using a Kaplan-Meier method showed a statistically significant difference between patients with cardiac death and those with no cardiac death using only the low flow match/mismatch (hazard ratio=0.29, P=0.01) and percentage max FDG match/mismatch criteria (hazard ratio=0.23, P=0.005) tools.
The low flow match/mismatch and percentage max FDG match/mismatch quantitative PET tools are useful for prognostic stratification of patients with ischemic cardiomyopathy undergoing myocardial viability assessment.
本研究旨在确定定量PET工具在对接受心肌存活评估的缺血性心肌病患者进行分层时的预后性能。
我们对104例连续的冠心病和既往心肌梗死患者应用了四种不同的定量工具，这些患者均接受了静息铷/门控氟脱氧葡萄糖（FDG）PET检查，以评估心肌存活情况，为潜在的血运重建做准备。其中一种工具仅基于FDG研究，另外三种工具通过将FDG与灌注参考数据库进行比较来评估匹配/不匹配缺陷的范围。本研究中用于定义存活的四种定量工具分别为：（i）仅FDG，计算左心室心肌（LVM）中FDG计数高于最大LVM FDG计数50%的百分比；（ii）低流量匹配/不匹配，与参考数据库相比，确定相对于定义的静息灌注缺陷，标准化FDG计数增加5%的区域；（iii）所有区域匹配/不匹配，计算相对于左心室静息灌注分布，标准化FDG计数增加10%的区域；（iv）最大FDG百分比匹配/不匹配，定义在参考数据库确定的定义灌注缺陷内，FDG摄取大于最大LVM FDG计数60%的区域。该分析的主要终点是心源性死亡。
在随访期（22±14个月）内，19例患者（18%）死亡；其中17例的死亡原因是心脏相关。使用单因素分析，没有一种方法能预测心源性死亡。受试者工作特征分析确定了四种工具在预测心源性死亡时心肌存活范围的最佳阈值：仅FDG = 20%，低流量匹配/不匹配 = 15%，所有区域匹配/不匹配 = 35%，最大FDG百分比匹配/不匹配 = 20%。使用Kaplan-Meier方法进行的删失生存分析显示，仅使用低流量匹配/不匹配（风险比 = 0.29，P = 0.01）和最大FDG百分比匹配/不匹配标准（风险比 = 0.23，P = 0.005）工具时，心源性死亡患者和无心源性死亡患者之间存在统计学显著差异。
低流量匹配/不匹配和最大FDG百分比匹配/不匹配定量PET工具可用于对接受心肌存活评估的缺血性心肌病患者进行预后分层。
