SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
J Nucl Cardiol. 2011 Aug;18(4):612-9. doi: 10.1007/s12350-011-9345-4. Epub 2011 May 28.
We assessed the prognostic value of coronary flow reserve (CFR) estimated by single-photon emission computed tomography (SPECT) in patients with suspected myocardial ischemia.
Myocardial perfusion and CFR were assessed in 106 patients using dipyridamole/rest Tc-99m sestamibi SPECT and follow-up was obtained in 103 (97%) patients. Four early revascularized patients were excluded and 99 were assigned to normal (summed stress score <3) vs abnormal myocardial perfusion and to normal (≥2.0) vs abnormal CFR. During the follow-up (5.8 ± 2.1 years), 28 patients experienced a cardiac event (cardiac death, nonfatal myocardial infarction, and late revascularization). Abnormal perfusion (P < .01) and abnormal CFR (P < .05) were independent predictors of cardiac events at Cox proportional hazard regression analysis. Also in patients with normal perfusion, abnormal CFR was associated with a higher annual event rate compared with normal CFR (5.2% vs 0.7%; P < .05). CFR data improved the prognostic power of the model including clinical and myocardial perfusion data increasing the global chi-square from 18.6 to 22.8 (P < .05). Finally, at parametric survival analysis, in patients with normal perfusion the time to achieve ≥2% risk of events was >60 months in those with normal and <12 months in those with abnormal CFR.
Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.
我们评估了单光子发射计算机断层扫描（SPECT）估计的冠状动脉血流储备（CFR）在疑似心肌缺血患者中的预后价值。
使用双嘧达莫/静息 Tc-99m sestamibi SPECT 评估了 106 例患者的心肌灌注和 CFR，并对 103 例（97%）患者进行了随访。排除了 4 例早期血运重建患者，99 例患者被分为正常（总和应激评分<3）与异常心肌灌注，以及正常（≥2.0）与异常 CFR。在随访期间（5.8±2.1 年），28 例患者发生了心脏事件（心脏死亡、非致死性心肌梗死和晚期血运重建）。Cox 比例风险回归分析显示，异常灌注（P<.01）和异常 CFR（P<.05）是心脏事件的独立预测因素。即使在灌注正常的患者中，异常 CFR 也与正常 CFR 相比，具有更高的年度事件发生率（5.2% vs. 0.7%；P<.05）。CFR 数据改善了包括临床和心肌灌注数据的模型的预后能力，使全局卡方从 18.6 增加到 22.8（P<.05）。最后，在参数生存分析中，在灌注正常的患者中，CFR 正常的患者达到≥2%事件风险的时间>60 个月，而 CFR 异常的患者<12 个月。
SPECT 成像的心肌灌注发现和 CFR 都是心脏事件的独立预测因素。估计的 CFR 提供了比从临床和心肌灌注数据获得的预后信息更具增量性的预后信息，特别是在灌注正常的患者中。
