Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
J Nucl Med. 2011 Jun;52(6):873-9. doi: 10.2967/jnumed.110.084954. Epub 2011 May 13.
Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention.
Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PET-driven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events.
One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 ± 11 y (96 men, 23 women); global left ventricle MPR was 1.54 ± 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age- and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P = 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.3-145.5) (P = 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P = 0.002).
Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.
本研究旨在探讨心肌血流储备（MPR）与 PET 驱动的缺血性心脏病（IHD）患者介入治疗后生存的关系。
1995 年至 2003 年间，119 例慢性 IHD 患者因 PET 评估的缺血-存活评估而接受了 PET 驱动的血运重建。对患者进行全因死亡率和主要心血管事件的随访。
119 例患者因心绞痛接受了 PET 驱动的血运重建（67 例经皮冠状动脉介入治疗，52 例冠状动脉旁路移植术）。患者的平均年龄为 67±11 岁（96 名男性，23 名女性）；左心室整体 MPR 为 1.54±0.43。MPR 三分位数的边界为 1.34 和 1.67。在最低和中间 MPR 三分位数中，观察到的心脏死亡明显多于最高三分位数。中间三分位数的年龄和性别校正风险比为 8.3（95%置信区间，1.02-68.3），最低三分位数为 23.6（95%置信区间，3.1-179）（P=0.002）。在将左心室射血分数（LVEF）和存活能力加入模型后，MPR 仍然具有显著性，风险比分别为 6.5（0.8-54.4）和 18.5（2.3-145.5）（P=0.004），而 LVEF 和存活能力在该模型中均无显著性。主要不良心脏事件的风险比分别为 3.15（0.82-12.0）和 8.24（2.36-28.8）（P=0.002），结果类似。
基于 PET 存活评估进行血运重建的 IHD 患者，如果 MPR 较低，则存在心脏死亡和随后的心脏事件风险。MPR 是心脏死亡的预测指标，比 LVEF 和存活能力更敏感。
