Jeong Hwan-Jeong, Lee Dong Soo, Lee Ho-Young, Choi SeHun, Han Yeon-Hee, Chung June-Key
Department of Nuclear Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute of Chonbuk National University Medical School & Hospital, Jeonju, Jeollabuk-do Korea.
Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yungun-dong Chongno-gu, Seoul, 110-744 Korea.
Nucl Med Mol Imaging. 2013 Sep;47(3):151-7. doi: 10.1007/s13139-013-0213-9. Epub 2013 Jul 20.
This study aimed at identifying the predictive parameters on quantitative gated myocardial perfusion single-photon emission computed tomography (QG-SPECT) in diabetic patients with normal perfusion but impaired function.
Among the 533 consecutive diabetic patients, 379 patients with normal perfusion on rest Tl-201/dipyridamole-stress Tc-99m sestamibi Gated SPECT were enrolled. Patients were grouped into those with normal post-stress left ventricular function (Group I) and those with impaired function (EF <50 or impaired regional wall motion, Group II). We investigated cardiac events and cause of death by chart review and telephone interview. Survival analysis and Cox proportional hazard model analysis were performed.
Between the Group I and II, cardiac events as well as chest pain symptoms, smoking, diabetic complications were significantly different (P < 0.05). On survival analysis, event free survival rate in Group II was significantly lower than in Group I (P = 0.016). In univariate Cox proportional hazard analysis on overall cardiac event, Group (II over I), diabetic nephropathy, summed motion score (SMS), summed systolic thickening score (STS), numbers of abnormal segmental wall motion and systolic thickening predicted more cardiac events (P < 0.05). Multivariate analysis showed that STS was the only independent predictor cardiac event.
The functional parameter, especially summed systolic thickening score on QG-SPECT had prognostic values, despite normal perfusion, in predicting cardiac events in diabetic patients, and QG-SPECT provides clinically useful risk stratification in diabetic patients with normal perfusion.
本研究旨在确定静息灌注正常但功能受损的糖尿病患者定量门控心肌灌注单光子发射计算机断层扫描（QG-SPECT）的预测参数。
在533例连续的糖尿病患者中，纳入379例静息铊-201/双嘧达莫负荷锝-99m 司他米比门控SPECT灌注正常的患者。患者被分为负荷后左心室功能正常组（I组）和功能受损组（射血分数<50或节段性室壁运动受损，II组）。我们通过查阅病历和电话访谈调查心脏事件和死亡原因。进行生存分析和Cox比例风险模型分析。
I组和II组之间，心脏事件以及胸痛症状、吸烟、糖尿病并发症存在显著差异（P<0.05）。生存分析显示，II组的无事件生存率显著低于I组（P = 0.016）。在总体心脏事件的单变量Cox比例风险分析中，（II组高于I组）、糖尿病肾病、总运动评分（SMS）、总收缩期增厚评分（STS）、节段性室壁运动和收缩期增厚异常节段数预测了更多的心脏事件（P<0.05）。多变量分析显示，STS是心脏事件的唯一独立预测因素。
尽管灌注正常，但QG-SPECT上的功能参数，尤其是总收缩期增厚评分，在预测糖尿病患者心脏事件方面具有预后价值，并且QG-SPECT为灌注正常的糖尿病患者提供了临床上有用的风险分层。
