Cardionuclear, Division of Nuclear Medicine, Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Porto Alegre, Brazil.
Clin Nucl Med. 2012 Aug;37(8):748-54. doi: 10.1097/RLU.0b013e31825ae755.
The prognostic significance of the difference between poststress and at rest left ventricular ejection fraction (ΔLVEF) in patients sent for diagnostic myocardial perfusion study (MPS) is not well characterized. The purpose of this study was to prospectively evaluate the ability of ΔLVEF in further risk stratifying these patients in addition to the severity/extent of myocardial perfusion abnormalities expressed as the total perfusion deficit at stress (sTPD), according to the type of stress used.
Two-day 99mTc-MIBI MPS after stress and rest were obtained for 507 patients subdivided according to the type of stress used, sTPD values, and ΔLVEF. Subsequent cardiac events were determined through a standardized questionnaire applied 1, 2, and 6 years after MPS. Independent of the type of stress used, the 6-year event rate with progressive perfusion and functional abnormalities combined was significant for total events, all-cause death, cardiac death, and revascularization but not for myocardial infarct. When ΔLVEF decreased by more than -10%, only those individuals with sTPD of 5% or less had increased 6-year total event rates [5.9% vs 15% for those submitted to treadmill test (P < 0.001) and 8.3% vs 19% when submitted to pharmacological stress (P = 0.001)]. An sTPD greater than 5% was the only variable predictive of total events when multivariate analysis was applied (P < 0.001 for treadmill exercise and P = 0.033 for dipyridamole).
Estimation of ΔLVEF in addition to sTPD seems to improve risk stratification for future events when ΔLVEF decreases by more than -10% for those individuals with normal or near-normal myocardial perfusion (sTPD ≤ 5%). An sTPD greater than 5% was a better prognostic indicator of future events when compared with ΔLVEF for individuals with greater perfusion abnormality at stress.
在接受诊断性心肌灌注研究（MPS）的患者中，应激后与休息时左心室射血分数（ΔLVEF）之间的差异的预后意义尚未得到很好的描述。本研究的目的是前瞻性评估ΔLVEF 在进一步风险分层这些患者中的能力，此外还评估了根据使用的应激类型表达的应激时总灌注缺陷（sTPD）的心肌灌注异常的严重程度/程度。
根据使用的应激类型、sTPD 值和ΔLVEF 将 507 例患者分为两天进行 99mTc-MIBI MPS 应激和休息后获得。通过应用于 MPS 后 1、2 和 6 年的标准化问卷确定随后的心脏事件。与使用的应激类型无关，随着灌注和功能异常的进行，总事件、全因死亡、心脏死亡和血运重建的 6 年事件发生率对于 sTPD 为 5%或更少的个体具有显著意义[对于进行踏车试验的个体，6 年总事件发生率为 5.9%比 15%（P<0.001），而对于进行药物应激的个体，6 年总事件发生率为 8.3%比 19%（P=0.001）]。只有当进行多变量分析时，sTPD 大于 5%才是总事件的唯一预测变量（对于踏车运动，P<0.001；对于双嘧达莫，P=0.033）。
当 ΔLVEF 降低超过-10%时，对于那些正常或接近正常心肌灌注（sTPD≤5%）的个体，除 sTPD 外，估计ΔLVEF 似乎可以改善未来事件的风险分层。当与应激时的更大灌注异常相比时，sTPD 大于 5%是未来事件的更好预后指标。
Zotero 插件