Metelková I, Kamínek M, Sovová E, Hutyra M, Budíková M, Buriánková E, Formánek R, Henzlová L, Metelka R
Klinika nukleární medicíny Lékarské fakulty UP a FN Olomouc.
Vnitr Lek. 2010 Nov;56(11):1122-9.
The aim of this study was to evaluate added value of coronary artery calcium score (CAC) measurement as an adjunct to cardiac gated SPECT for risk stratification in population of patients with diabetes mellitus (DM) and/or chronic renal failure on hemodialysis (CHRF-HD).
Retrospective analysis of 67 patients, who were referred for stress gated myocardial perfusion SPECT and CAC. Characteristics of study population: 40 men, mean age 59 +/- 12 years, DM (n = 28), CHRF-HD (n = 22), DM and CHRF-HD simultaneously (n = 17). Perfusion summed stress and different scores (SSS, SDS), the left ventricle ejection fraction (LVEF) and enddiastolic/endsystolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT software. The hard cardiac event was defined as sudden cardiac death or myocardial infarction (MI); angina or other symptoms requiring coronary revascularization were also calculated.
During the average period of 18 +/- 10 months, we registered 8 cardiac deaths, 4 nonfatal MI and 7 patients underwent revascularization. In the subgroup of 19 patients with cardiac events, the observed parameters were significantly worse concerning perfusion (SSS 9 +/- 11 vs 2 +/- 3 and SDS 6 +/- 9 vs 1 +/- 2, P < 0.05), the left ventricle function (stress LVEF 53% +/- 13% vs 59% +/- 13%, rest LVEF 55% +/- 14% vs 59% +/- 12%, stress EDV/ESV 144 ml/71 ml vs 128 ml/59 ml, P < 0.05), and CAC score (1 965 +/- 1 772 vs 387 +/- 740, P < 0.05) in comparison with patients without cardiac event. In patients without a reversible perfusion abnormality (SDS < 2), we observed lower annual hard event rate (8% vs 19.6%, P < 0.05) and revascularization procedures (4% vs 19.6%, P < 0.05) in comparison with patients with SDS > or = 2. In patients with or without reversible defects, we registered significantly higher annual hard event rate in the setting of post-stress worsening of the LVEF > 5% and/or severe CAC score > or = 709 (23.8% vs 1.9% in patients with SDS < 2, and 26.7% vs 9.5% in patients with SDS > or = 2, P < 0.05).
The findings of highly elevated CAC score as well as the post-stress left ventricle stunning enable further risk stratification in patients with or without reversible perfusion abnormalities.
本研究旨在评估冠状动脉钙化评分（CAC）测量作为心脏门控单光子发射计算机断层扫描（SPECT）辅助手段，在糖尿病（DM）和/或接受血液透析的慢性肾衰竭（CHRF - HD）患者群体中进行风险分层的附加价值。
对67例因负荷门控心肌灌注SPECT和CAC检查而就诊的患者进行回顾性分析。研究人群特征：40名男性，平均年龄59±12岁，DM患者28例，CHRF - HD患者22例，同时患有DM和CHRF - HD的患者17例。使用4D - MSPECT软件自动计算负荷灌注总和及不同评分（SSS、SDS）、左心室射血分数（LVEF）以及舒张末期/收缩末期容积（EDV/ESV）。将严重心脏事件定义为心源性猝死或心肌梗死（MI）；还计算了心绞痛或其他需要冠状动脉血运重建的症状。
在平均18±10个月的观察期内，我们记录到8例心源性死亡、4例非致命性MI以及7例接受血运重建的患者。在19例发生心脏事件的患者亚组中，与未发生心脏事件的患者相比，观察到的灌注参数（SSS：分别为9±11和2±3，SDS：分别为6±9和1±2，P<0.05）、左心室功能（负荷LVEF：分别为53%±13%和59%±13%，静息LVEF：分别为55%±14%和59%±12%，负荷EDV/ESV：分别为144 ml/71 ml和128 ml/59 ml，P<0.05）以及CAC评分（分别为1965±1772和387±740，P<0.05）明显更差。在无可逆性灌注异常（SDS<2）的患者中，与SDS≥2的患者相比，我们观察到年度严重事件发生率较低（8%对19.6%，P<0.05）以及血运重建手术率较低（4%对19.6%，P<0.05）。在有或无可逆性缺损的患者中，如果负荷后LVEF恶化>5%和/或严重CAC评分≥709，我们记录到年度严重事件发生率显著更高（SDS<2的患者中为23.8%对1.9%，SDS≥2的患者中为26.7%对9.5%，P<0.05）。
CAC评分显著升高以及负荷后左心室顿抑的发现能够对有或无可逆性灌注异常的患者进行进一步的风险分层。
