JACC Cardiovasc Imaging. 2009 Dec;2(12):1393-400. doi: 10.1016/j.jcmg.2009.09.010.
The purpose of this study was to evaluate the predictive value of perfusion/function parameters measured by gated myocardial perfusion single-photon emission computed tomography (SPECT)in combination with clinical variables in patients with known or suspected coronary artery disease to predict refractory heart failure (HF).
The increasing number of HF patients requires the establishment of a prophylactic strategy that can identify patients at high risk of HF due to coronary artery disease.
We analyzed clinical and stress/rest-gated SPECT data from the multicenter, prospective, and observational J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) database of 3,835 known or suspected coronary artery disease patients in which new-onset congestive HF symptoms requiring aggressive medical treatment were observed in 71 patients for 3 years.
The multivariable Cox hazard model revealed that chronic renal dysfunction (hazard ratio(HR): 6.227 [95% confidence interval (CI): 2.920 to 13.279]), the end-systolic volume index (ESVI) (HR:1.019 [95% CI: 1.011 to 1.029]), and moderate to high stress summed score (SSS) (HR: 3.012 [95% CI: 1.757 to 5.181]) independently (p < 0.0001) predicted HF. In addition to the close (p < 0.0001) correlation of ESVI and SSS with HF incidence, the combined tertiles of SSS and ESVI revealed high-risk patients with a maximally 17.3 times greater risk (5.2%/3 years) compared with the minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI. Chronic renal dysfunction combined with ESVI and SSS categories had the greatest (p < 0.005 to 0.001) incremental prognostic value with a global chi-square value (125.0)over single or other combined risks.
Chronic renal dysfunction, greater stress-induced perfusion abnormality, and higher ESVI provide independent and additive information for predicting the risk of refractory HF in known or suspected coronary patients, indicating the efficacy of perfusion/function parameters measured by stress gated perfusion SPECT for identifying patients at greater risk of future refractory HF.
本研究旨在评估通过门控心肌灌注单光子发射计算机断层扫描（SPECT）测量的灌注/功能参数与临床变量相结合，对已知或疑似冠心病患者预测难治性心力衰竭（HF）的预测价值。
越来越多的 HF 患者需要建立一种预防性策略，以便能够识别出因冠心病而 HF 风险较高的患者。
我们分析了来自多中心、前瞻性、观察性 J-ACCESS（日本通过定量门控 SPECT 评估心脏事件和生存研究）数据库的 3835 名已知或疑似冠心病患者的临床和应激/静息门控 SPECT 数据，其中 71 例患者在 3 年内出现了需要积极药物治疗的新发充血性 HF 症状。
多变量 Cox 风险模型显示，慢性肾功能不全（危险比（HR）：6.227[95%置信区间（CI）：2.920 至 13.279]）、收缩末期容积指数（ESVI）（HR：1.019[95%CI：1.011 至 1.029]）和中至高应激总和得分（SSS）（HR：3.012[95%CI：1.757 至 5.181]）独立地（p<0.0001）预测 HF。除了 ESVI 和 SSS 与 HF 发生率密切相关（p<0.0001）外，SSS 和 ESVI 的联合三分位数还显示出高危患者的风险最高，高达 17.3 倍（5.2%/3 年），而风险最低的患者（0.3%/3 年）为低 SSS 和较低的 ESVI。慢性肾功能不全合并 ESVI 和 SSS 类别具有最大的（p<0.005 至 0.001）增量预后价值，全局卡方值（125.0）超过单一或其他联合风险。
慢性肾功能不全、更大的应激诱导灌注异常和更高的 ESVI 为预测已知或疑似冠心病患者难治性 HF 的风险提供了独立且附加的信息，表明应激门控灌注 SPECT 测量的灌注/功能参数可用于识别未来发生难治性 HF 风险较高的患者。
