Romero-Farina G, Candell-Riera J, Aguadé-Bruix S, Cuberas-Borrós G, Pizzi M N, Santos A, de León G, García-Dorado D
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España.
Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España.
Rev Esp Med Nucl Imagen Mol. 2014 Mar-Apr;33(2):72-8. doi: 10.1016/j.remn.2013.06.009. Epub 2013 Aug 12.
The objective of this study was to investigate predictor variables at the moment of normal stress-rest myocardial perfusion gated SPECT for indication of a second gated SPECT.
A prospective, single center cohort study was conducted. We evaluated 2326 consecutive patients (age 63.6 ± 13 years, 57.3% females) without perfusion defects and with normal left ventricular ejection fraction on a myocardial perfusion gated SPECT. Clinical and stress test variables were studied to predict indication of a second gated SPECT and presence of reversible perfusion defects in the second gated SPECT.
During a mean follow-up of 3.6 ± 2 years a second gated SPECT was performed in 286 patients (12.3%). Independent predictor variables of a second gated SPECT were presence of three or more cardiovascular risk factors (χ(2): 5.510; HR: 1.4; p=0.019), previous acute myocardial infarction (χ(2): 3.867; HR: 1.4; p=0.049), previous coronary revascularization (χ(2): 41.081; HR: 2.5; p<0.001), and a positive stress test (χ(2): 8.713; HR: 1.5; p=0.003). Observation of perfusion defects in the 280 patients in whom a second stress-rest gated SPECT was performed was more likely in male patients (χ(2): 4.322; HR: 1.9; p=0.038) who had a first pure pharmacological gated-SPECT (χ(2): 7.182; HR: 2.6; p=0.007).
In patients with a first normal myocardial perfusion gated SPECT, various clinical factors and variables derived from the stress test affect the indication of a second gated SPECT and the presence of ischemia in the latter.
本研究的目的是调查在静息-负荷心肌灌注门控单光子发射计算机断层显像（SPECT）时的预测变量，以用于指示进行第二次门控SPECT。
进行了一项前瞻性、单中心队列研究。我们评估了2326例连续的患者（年龄63.6±13岁，57.3%为女性），这些患者在心肌灌注门控SPECT上无灌注缺损且左心室射血分数正常。研究临床和负荷试验变量，以预测第二次门控SPECT的指征以及第二次门控SPECT中可逆性灌注缺损的存在情况。
在平均3.6±2年的随访期间，286例患者（12.3%）进行了第二次门控SPECT。第二次门控SPECT的独立预测变量包括存在三个或更多心血管危险因素（χ²：5.510；风险比：1.4；p=0.019）、既往急性心肌梗死（χ²：3.867；风险比：1.4；p=0.049）、既往冠状动脉血运重建（χ²：41.081；风险比：2.5；p<0.001）以及负荷试验阳性（χ²：8.713；风险比：1.5；p=0.003）。在进行第二次静息-负荷门控SPECT的280例患者中，男性患者（χ²：4.322；风险比：1.9；p=0.038）以及首次进行单纯药物门控SPECT的患者（χ²：7.182；风险比：2.6；p=0.007）更有可能观察到灌注缺损。
在首次心肌灌注门控SPECT正常的患者中，各种临床因素和负荷试验得出的变量会影响第二次门控SPECT的指征以及后者中缺血情况的存在。
