通过正电子发射断层扫描评估的缺血模式可预测特发性扩张型心肌病患者的不良预后。
Ischemic patterns assessed by positron emission tomography predict adverse outcome in patients with idiopathic dilated cardiomyopathy.
作者信息
de Jong Richard M, Tio Rene A, van der Harst Pim, Voors Adriaan A, Koning Paul M, Zeebregts Clark J A M, van Veldhuisen Dirk J, Dierckx Rudi A J O, Slart Riemer H J A
机构信息
Thoraxcenter, Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
出版信息
J Nucl Cardiol. 2009 Sep-Oct;16(5):769-74. doi: 10.1007/s12350-009-9130-9. Epub 2009 Aug 1.
BACKGROUND
Although patients with idiopathic dilated cardiomyopathy (DCM) have no coronary artery disease, regional impairment of myocardial perfusion combined with preserved metabolism has been found using positron emission tomography (PET). Our aim was to assess the prognostic relevance of PET-mismatch between stress myocardial perfusion and glucose uptake on clinical outcome in DCM.
METHODS
In 24 patients with DCM who underwent both myocardial perfusion and metabolism PET scanning, "mismatch" was assessed and the association with clinical outcome (hospitalization, mortality, and heart transplantation) was investigated.
RESULTS
Mismatch was found in 16 patients (66.7%). Univariate analysis showed that the presence of mismatch was associated with adverse outcome (P = 0.03). After adjustment for sex and age, the association remained significant with an adjusted relative risk of 10.4 (95% CI 1.1-103; P = 0.04) for death, heart transplant, or hospitalization. Univariate analysis also showed that a higher extent of mismatch was significantly associated with adverse outcome (P = 0.02). After adjusting for sex and age, the association remained significant with an adjusted relative risk of 6.5 [95% CI 1.2-36; P = 0.03] for death, heart transplantation, or hospitalization.
CONCLUSION
PET stress perfusion-metabolism mismatch, indicative for ischemia, is frequently found in DCM patients and related to a poorer outcome.
背景
尽管特发性扩张型心肌病（DCM）患者没有冠状动脉疾病，但使用正电子发射断层扫描（PET）发现心肌灌注存在局部损害而代谢保持正常。我们的目的是评估DCM患者中应激心肌灌注与葡萄糖摄取之间PET不匹配对临床结局的预后相关性。
方法
对24例接受心肌灌注和代谢PET扫描的DCM患者进行“不匹配”评估，并研究其与临床结局（住院、死亡率和心脏移植）的相关性。
结果
16例患者（66.7%）存在不匹配。单因素分析显示，不匹配的存在与不良结局相关（P = 0.03）。在对性别和年龄进行校正后，死亡、心脏移植或住院的校正相对风险为10.4（95%CI 1.1 - 103；P = 0.04），这种相关性仍然显著。单因素分析还显示，更高程度的不匹配与不良结局显著相关（P = 0.02）。在对性别和年龄进行校正后，死亡、心脏移植或住院的校正相对风险为6.5[95%CI 1.2 - 36；P = 0.03]，这种相关性仍然显著。
结论
PET应激灌注 - 代谢不匹配提示存在缺血，在DCM患者中经常发现，且与较差的结局相关。
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