Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, Larissa, 41110, Greece.
Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):789-98. doi: 10.1007/s00259-009-1312-9. Epub 2009 Dec 17.
The aim of this study was to determine the long-term prognostic value of early poststress lung/heart ratio (LHR) of (99m)Tc-tetrofosmin radioactivity.
We studied 276 patients (aged 62.2 + or - 8.9 years, 168 men) with stress/rest (99m)Tc-tetrofosmin myocardial gated-SPECT and coronary angiography. To evaluate myocardial ischaemia, we calculated the summed stress score, summed rest score and summed difference score indices. For the eLHR calculation, an anterior image was acquired, 4-6 min after radiotracer injection at stress (eLHR was defined as mean counts per pixel in the lung region of interest divided by the mean counts per pixel in the myocardial region of interest). Cardiovascular death and nonfatal myocardial infarction were considered as hard cardiac events, and late revascularization procedures as soft cardiac events. The Cox proportional hazards model in a stepwise method was used to determine the independent predictors for hard and soft cardiac events.
During the follow-up period hard cardiac events occurred in 28 patients (10.1%) and soft cardiac events in 32 patients (11.6%). Implying multiple Cox regression analysis, eLHR was found to be a significant independent predictor for both soft and hard cardiac events. The hazard ratio (for a 0.1 unit increase) was 4.41 (95% CI 1.52-12.73, p=0.006) for soft cardiac events and 4.22 (95% CI 2.07-8.62, p<0.001) for hard cardiac events. The other significant prognostic factors were use of beta-blockers, the summed stress score and the use of nitrates for soft events, and exercise duration and the summed stress score for hard cardiac events.
Early poststress (99m)Tc-tetrofosmin LHR has an independent and powerful value in predicting hard and soft cardiac events.
本研究旨在确定早期应激后（99m）Tc-四氮茂肺/心比值（LHR）放射性对（99m）Tc-四氮茂放射性的长期预后价值。
我们研究了 276 例（年龄 62.2±8.9 岁，男性 168 例）应激/休息（99m）Tc-四氮茂心肌门控 SPECT 和冠状动脉造影患者。为了评估心肌缺血，我们计算了总和应激评分、总和静息评分和总和差异评分指数。对于 eLHR 计算，在应激后 4-6 分钟时采集前位图像（eLHR 定义为肺感兴趣区的平均像素计数除以心肌感兴趣区的平均像素计数）。心血管死亡和非致死性心肌梗死被认为是硬心脏事件，晚期血运重建被认为是软心脏事件。采用逐步 Cox 比例风险模型确定硬心脏事件和软心脏事件的独立预测因子。
在随访期间，28 例患者发生硬心脏事件（10.1%），32 例患者发生软心脏事件（11.6%）。多因素 Cox 回归分析表明，eLHR 是软心脏事件和硬心脏事件的独立预测因子。风险比（每增加 0.1 个单位）为 4.41（95%CI 1.52-12.73，p=0.006），软心脏事件 4.22（95%CI 2.07-8.62，p<0.001），硬心脏事件。其他重要的预后因素包括β受体阻滞剂的使用、总和应激评分和硝酸盐的使用与软事件相关，运动时间和总和应激评分与硬心脏事件相关。
早期应激（99m）Tc-四氮茂 LHR 对预测硬心脏事件和软心脏事件具有独立和强大的价值。
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