Filipiak-Strzecka Dominika, Kowalczyk Ewelina, Hamala Piotr, Kot Nina, Kasprzak Jarosław D, Kuśmierek Jacek, Płachcińska Anna, Lipiec Piotr
Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Lodz, Poland.
Clin Physiol Funct Imaging. 2013 May;33(3):218-23. doi: 10.1111/cpf.12016. Epub 2013 Jan 2.
To assess the long-term prognostic value of various types of perfusion defects detected by single-photon emission computed tomography (SPECT) in patients with stable angina.
Seven hundred and thirty two patients (299 men, mean age 57 ± 9 years) with suspected or known stable coronary artery disease underwent rest/exercise SPECT protocol using 99mTc-methoxyisobutylisonitrile (MIBI). All patients completed clinical follow-up regarding cardiac events (cardiac death, sudden cardiac death, acute coronary syndrome, revascularization, cardiac hospitalization) for a mean period of 58 ± 8 months. Event rates were analysed in subgroups defined according to the presence of fixed or inducible myocardial perfusion defects.
During the follow-up, 15 cardiac deaths were recorded, 13 of which were qualified as a sudden cardiac death, 59 acute coronary syndromes, 65 revascularizations and 209 cardiac hospitalizations. The presence of inducible perfusion defects on SPECT was associated with a high risk for occurrence of all analysed end points: sudden cardiac death (HR = 3·96, P = 0·01), cardiac hospitalization (HR = 1·5, P = 0·004), coronary syndrome (HR = 2·33, P = 0·001) and coronary revascularization (HR = 2·76, P = 0·0002), except for the cardiac death (P = 0·27). Resting perfusion defects were highly predictive for cardiac death (HR = 7·45; P = 0·001), but not for other cardiac events (P = NS). The presence of any (inducible or resting) perfusion defects was associated with a high risk of all cardiovascular complications.
In long-term follow-up, SPECT proved highly predictive of cardiac events in patients with suspected or known CAD. In the revascularization era, cardiac death is most accurately related to the presence of resting perfusion defects, but all other cardiac events were better predicted by inducible perfusion defects.
评估单光子发射计算机断层扫描（SPECT）检测到的各种类型灌注缺损对稳定型心绞痛患者的长期预后价值。
732例（299例男性，平均年龄57±9岁）疑似或已知患有稳定型冠状动脉疾病的患者接受了使用99mTc-甲氧基异丁基异腈（MIBI）的静息/运动SPECT检查方案。所有患者均完成了关于心脏事件（心源性死亡、心源性猝死、急性冠状动脉综合征、血运重建、心脏住院）的平均为期58±8个月的临床随访。根据固定或可逆性心肌灌注缺损的存在情况对亚组的事件发生率进行分析。
在随访期间，记录到15例心源性死亡，其中13例被判定为心源性猝死，59例急性冠状动脉综合征，65例血运重建和209例心脏住院。SPECT上存在可逆性灌注缺损与所有分析的终点事件发生风险高相关：心源性猝死（HR = 3.96，P = 0.01）、心脏住院（HR = 1.5，P = 0.004）、冠状动脉综合征（HR = 2.33，P = 0.001）和冠状动脉血运重建（HR = 2.76，P = 0.0002），心源性死亡除外（P = 0.27）。静息灌注缺损对心源性死亡具有高度预测性（HR = 7.45；P = 0.001），但对其他心脏事件无预测性（P = 无显著性差异）。任何（可逆性或静息性）灌注缺损的存在均与所有心血管并发症的高风险相关。
在长期随访中，SPECT被证明对疑似或已知CAD患者的心脏事件具有高度预测性。在血运重建时代，心源性死亡与静息灌注缺损的存在最为密切相关，但所有其他心脏事件通过可逆性灌注缺损能得到更好的预测。
