Servei de Cardiologia, Àrea del Cor, Hospital Universitari Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Clin Nucl Med. 2012 Oct;37(10):965-70. doi: 10.1097/RLU.0b013e318263907b.
Ischemic cardiomyopathy (ICM) is a disease with high morbidity and mortality. There are several published studies on the evolution and prognosis of patients with ICM. However, reports on the therapeutic management in clinical practice are scarce. The aim of this study was to analyze coronary revascularization (CR) performance in patients with ICM and suitable coronary anatomy according to myocardial perfusion stress-rest gated SPECT results.
Eighty-seven consecutive patients (mean age, 62.4 y; 20 women), with ischemic heart disease, left ventricular ejection fraction of 40% or less, coronary anatomy suitable for CR, and without previous CR, were evaluated by means of stress-rest gated SPECT.
Sixty-four percent of patients had scintigraphic criteria of viability and 62.1% showed scintigraphic ischemia in stress-rest gated SPECT. Forty-five percent of patients were revascularized, and the remainder received medical treatment only. Coronary revascularization was more frequent in patients with scintigraphic viability (P = 0.012), in those with scintigraphic ischemia (P = 0.007), and in those with low left ventricular end-systolic volume (P = 0.006). Cox regression analysis identified multivessel disease [hazard ratio (HR), 3.3; 95% confidence interval (CI), 4-7.8], summed difference score greater than 4 (HR, 3.9; 95% CI, 1.5-9.8), and left ventricular end-systolic volume less than 120 mL (HR, 3.2; 95% CI, 1.3-8.2) as the best independent predictors of CR treatment.
In patients with ICM and suitable coronary arteries who are able to perform a stress myocardial perfusion-gated SPECT, the presence of multivessel disease and myocardial ischemia and the absence of severely increased left ventricular volume were associated to a decision of CR.
缺血性心肌病（ICM）是一种发病率和死亡率都很高的疾病。有几项关于 ICM 患者的演变和预后的已发表研究。然而，关于临床实践中的治疗管理的报告却很少。本研究的目的是根据心肌灌注应激-静息门控 SPECT 结果分析 ICM 患者和合适冠状动脉解剖结构的冠状动脉血运重建（CR）表现。
87 例连续患者（平均年龄 62.4 岁；20 名女性），患有缺血性心脏病，左心室射血分数为 40%或更低，冠状动脉解剖结构适合 CR，且之前未进行过 CR，通过应激-静息门控 SPECT 进行评估。
64%的患者具有放射性核素存活的影像学标准，62.1%的患者在应激-静息门控 SPECT 上显示放射性核素缺血。45%的患者接受了血运重建，其余患者仅接受了药物治疗。在具有放射性核素存活的患者（P=0.012）、具有放射性核素缺血的患者（P=0.007）和左心室收缩末期容积较低的患者（P=0.006）中，CR 更为常见。Cox 回归分析确定多支血管疾病[风险比（HR），3.3；95%置信区间（CI），4-7.8]、总和差异评分大于 4（HR，3.9；95% CI，1.5-9.8）和左心室收缩末期容积小于 120mL（HR，3.2；95% CI，1.3-8.2）是 CR 治疗的最佳独立预测因子。
在能够进行应激心肌灌注门控 SPECT 的 ICM 患者和合适的冠状动脉患者中，多支血管疾病和心肌缺血的存在以及严重增加的左心室容积的不存在与 CR 的决策相关。
