Kayano Daiki, Nakajima Kenichi, Ohtake Hiroshi, Kinuya Seigo
Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
Ann Nucl Med. 2009 Feb;23(2):173-81. doi: 10.1007/s12149-008-0228-y. Epub 2009 Feb 19.
Myocardial perfusion single photon emission computed tomography (SPECT) is useful for preoperative cardiac risk stratification. We investigated the value of preoperative pharmacologic stress electrocardiographic (ECG)-gated myocardial perfusion SPECT for noncardiac vascular surgery.
To assess the perioperative cardiac risk for noncardiac vascular surgery, preoperative pharmacologic stress ECG-gated myocardial perfusion SPECT was performed in 211 consecutive patients who underwent noncardiac aortic surgery. We examined myocardial perfusion and left ventricular function by the quantitative gated SPECT (QGS), and the correlation with perioperative cardiac events was investigated.
Perioperative cardiac events occurred in 9 of 211 patients (4.3%). On the basis of univariate analysis, significant predictors for preoperative cardiac risk stratification included history of heart failure (P < 0.05), history of coronary artery revascularization (P < 0.05), summed stress score (SSS) (P < 0.0001), summed rest score (SRS) (P < 0.005), SSS > or = 7 (P < 0.005), end-diastolic volume (EDV) > or = mean + 2 standard deviation (SD) (134 ml for men and 93 ml for women) (P < 0.005), end-systolic volume (ESV) > or = mean + 2 SD (60 ml for men and 37 ml for women) (p < 0.0001), left ventricular ejection fraction (EF) < or = mean - 2 SD (48% for men and 55% for women) (P < 0.005) and wall motion abnormality (P < 0.05). On the basis of multivariate analysis, ESV > or = mean + 2 SD was the only independent predictor for perioperative cardiac events (P < 0.005).
Pharmacologic stress ECG-gated myocardial perfusion SPECT, which permits assessment of both myocardial perfusion and cardiac function, is useful for preoperative risk stratification of noncardiac vascular surgery.
心肌灌注单光子发射计算机断层扫描（SPECT）对术前心脏风险分层有用。我们研究了术前药物负荷心电图（ECG）门控心肌灌注SPECT在非心脏血管手术中的价值。
为评估非心脏血管手术的围手术期心脏风险，对211例连续接受非心脏主动脉手术的患者进行了术前药物负荷ECG门控心肌灌注SPECT检查。我们通过定量门控SPECT（QGS）检查心肌灌注和左心室功能，并研究其与围手术期心脏事件的相关性。
211例患者中有9例（4.3%）发生围手术期心脏事件。单因素分析显示，术前心脏风险分层的显著预测因素包括心力衰竭病史（P<0.05）、冠状动脉血运重建病史（P<0.05）、负荷总分（SSS）（P<0.0001）、静息总分（SRS）（P<0.005）、SSS≥7（P<0.005）、舒张末期容积（EDV）≥平均值+2标准差（SD）（男性为134 ml，女性为93 ml）（P<0.005）、收缩末期容积（ESV）≥平均值+2 SD（男性为60 ml，女性为37 ml）（P<0.0001）、左心室射血分数（EF）≤平均值-2 SD（男性为48%，女性为55%）（P<0.005）和室壁运动异常（P<0.05）。多因素分析显示，ESV≥平均值+2 SD是围手术期心脏事件唯一的独立预测因素（P<0.005）。
药物负荷ECG门控心肌灌注SPECT可同时评估心肌灌注和心脏功能，对非心脏血管手术的术前风险分层有用。
