特发性扩张型心肌病患者β受体阻滞剂治疗后的心肌灌注储备和收缩模式。

Myocardial perfusion reserve and contractile pattern after beta-blocker therapy in patients with idiopathic dilated cardiomyopathy.

机构信息

Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.

出版信息

J Nucl Cardiol. 2010 Jun;17(3):479-85. doi: 10.1007/s12350-010-9216-4. Epub 2010 Mar 18.

DOI:10.1007/s12350-010-9216-4

PMID:20238193

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2866962/

Abstract

BACKGROUND

In Idiopathic Dilated Cardiomyopathy (IDC) an imbalance between myocardial oxygen consumption and supply has been postulated. The ensuing subclinical myocardial ischemia may contribute to progressive deterioration of LV function. beta-blocker is the therapy of choice in these patients. However, not all patients respond to the same extent. The aim of this study was to elucidate whether differences between responders and non-responders can be identified with respect to regional myocardial perfusion reserve (MPR) and contractile performance.

METHODS

Patients with newly diagnosed IDC underwent Positron Emission Tomography (PET) scanning using both (13)N-ammonia as a perfusion tracer (baseline and dipyridamole stress), and (18)F-fluoro-deoxyglucose as a metabolism tracer, and a dobutamine stress MRI. MRI and PET were repeated 6 months after maximal beta-blocker therapy. MPR (assessed by PET) as well as wall motion score (WMS, assessed by MRI) were evaluated in a 17 segment-model. Functional response to beta-blocker therapy was assigned as a stable or improved LVEF or diminished LVEF.

RESULTS

Sixteen patients were included (age 47.9 +/- 11.5 years; 12 males, LVEF 28.6 +/- 8.4%). Seven patients showed improved LVEF (9.7 +/- 3.1%), and nine patients did not show improved LVEF (-3.4 +/- 3.9%). MPR improved significantly in responders (1.56 +/- .23 to 1.93 +/- .49, P = .049), and MPR decreased in non-responders; however, not significantly (1.98 +/- .70 to 1.61 +/- .28, P = .064), but was significantly different between both groups (P = .017) after beta-blocker therapy. A significant correlation was found between change in perfusion reserve and change in LVEF: a decrease in perfusion reserve was associated with a decrease in LVEF and vice versa. Summed rest score of wall motion in responders improved from 26 to 21 (P = .022) whereas in non-responders no change was observed from 26 to 25) (P = ns). Summed stress score of wall motion in responders improved from 23 to 21 (P = .027) whereas in non-responders no change was observed from 27 to 26) (P = ns).

CONCLUSION

In IDC patients, global as well as regional improvement after initiation of beta-blocker treatment is accompanied by an improvement in regional perfusion parameters. On the other hand in IDC patients with further left ventricular function deterioration after initiation of beta-blocker therapy this is accompanied by a decrease in perfusion reserve.

摘要

背景

在特发性扩张型心肌病（IDC）中，心肌耗氧量和供氧量之间的不平衡已经被假定存在。由此导致的亚临床心肌缺血可能导致 LV 功能进行性恶化。β受体阻滞剂是这些患者的首选治疗方法。然而，并非所有患者都能达到相同的效果。本研究旨在阐明在局部心肌灌注储备（MPR）和收缩性能方面，能否识别出应答者和无应答者之间的差异。

方法

新诊断为 IDC 的患者接受正电子发射断层扫描（PET）扫描，使用（13）N-氨作为灌注示踪剂（基线和双嘧达莫应激）和（18）F-氟脱氧葡萄糖作为代谢示踪剂，并进行多巴酚丁胺应激 MRI。在最大β受体阻滞剂治疗后 6 个月重复 MRI 和 PET。通过 17 节段模型评估 MPR（通过 PET 评估）和壁运动评分（WMS，通过 MRI 评估）。β受体阻滞剂治疗的功能反应被指定为稳定或改善的 LVEF 或降低的 LVEF。

结果

共纳入 16 例患者（年龄 47.9±11.5 岁；12 例男性，LVEF 28.6±8.4%）。7 例患者 LVEF 改善（9.7±3.1%），9 例患者 LVEF 未改善（-3.4±3.9%）。应答者的 MPR 显著改善（1.56±.23 至 1.93±.49，P=.049），而非应答者的 MPR 下降；然而，差异无统计学意义（1.98±.70 至 1.61±.28，P=.064），但在β受体阻滞剂治疗后两组之间差异有统计学意义（P=.017）。发现灌注储备的变化与 LVEF 的变化之间存在显著相关性：灌注储备的下降与 LVEF 的下降相关，反之亦然。应答者的静息评分总和从 26 分提高到 21 分（P=.022），而非应答者从 26 分提高到 25 分（P=ns）。应答者的应激评分总和从 23 分提高到 21 分（P=.027），而非应答者从 27 分提高到 26 分（P=ns）。