Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Liver Transpl. 2011 Mar;17(3):261-9. doi: 10.1002/lt.22234.
A cardiac evaluation before orthotopic liver transplantation (OLT) is imperative. Previous investigations have demonstrated that mild to moderate reversible perfusion defects on myocardial perfusion scintigraphy (MPS) in general are associated with a low risk for perioperative cardiac events. The objective of this study was to assess any perfusion defects in consecutive patients with chronic liver disease who were undergoing OLT. OLT candidates underwent extensive cardiovascular screening that included, among other methods, MPS. Patients who had no contraindications for surgery and underwent OLT were followed up. The occurrence and risk of complications and mortality were compared in 3 groups of patients: patients with normal MPS results, patients with any reversible defect, and patients with a fixed perfusion defect on MPS. In all, 156 subsequent patients underwent OLT. One or more reversible segmental perfusion defects on MPS were present in 14 patients (<3 segments, n = 12; 3 segments without obstructive coronary artery disease, n = 2). The risk of complications did not differ significantly between patients with normal MPS findings and patients with a reversible perfusion defect (odds ratio = 3.04, 95% confidence interval = 0.65-14.26, P = 0.16), although the study was not sufficiently powered to show a difference. The presence of 1 or more reversible defects on MPS was significantly associated with an increased incidence of all-cause 1-year mortality (hazard ratio = 3.17, 95% confidence interval = 1.02-9.83, P = 0.046). No significant difference in the outcomes of patients with normal MPS findings and patients with a fixed defect on MPS was found; the study was, however, not adequately powered to do so. In conclusion, the results of this small cohort study indicate that patients with mild to moderate reversible perfusion defects on MPS may have inferior survival characteristics in comparison with patients with normal MPS results. A prospective, adequately powered study is required to confirm the results of this study.
在原位肝移植（OLT）前进行心脏评估是至关重要的。先前的研究表明，心肌灌注闪烁显像（MPS）上的轻度至中度可逆性灌注缺陷通常与围手术期心脏事件的低风险相关。本研究的目的是评估接受 OLT 的慢性肝病连续患者是否存在任何灌注缺陷。OLT 候选者接受了广泛的心血管筛查，其中包括 MPS 等方法。没有手术禁忌症并接受 OLT 的患者接受了随访。在 3 组患者中比较了并发症和死亡率的发生和风险：MPS 结果正常的患者、有任何可逆性缺陷的患者和 MPS 上有固定灌注缺陷的患者。共有 156 名后续患者接受了 OLT。14 名患者（<3 个节段，n=12；无阻塞性冠状动脉疾病的 3 个节段，n=2）的 MPS 上存在 1 个或多个可逆性节段性灌注缺陷。MPS 检查结果正常的患者和有可逆性灌注缺陷的患者之间并发症的风险没有显著差异（比值比=3.04，95%置信区间=0.65-14.26，P=0.16），尽管该研究没有足够的效力来显示差异。MPS 上存在 1 个或多个可逆性缺陷与全因 1 年死亡率的增加显著相关（风险比=3.17，95%置信区间=1.02-9.83，P=0.046）。MPS 检查结果正常的患者和 MPS 上有固定缺陷的患者的结局没有显著差异；然而，该研究没有足够的效力来做到这一点。总之，这项小队列研究的结果表明，MPS 上有轻度至中度可逆性灌注缺陷的患者的生存特征可能不如 MPS 检查结果正常的患者。需要进行前瞻性、有足够效力的研究来证实本研究的结果。
