Marcassa Claudio, Campini Riccardo, Calza Paolo, Zoccarato Orazio
Department of Cardiology, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), via Revislate 13, Veruno, 28010, NO, Italy.
Department of Nuclear Medicine, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), Veruno, Italy.
Eur J Nucl Med Mol Imaging. 2016 Jul;43(8):1513-21. doi: 10.1007/s00259-016-3355-z. Epub 2016 Mar 12.
Few data exist on the correlation between the effectiveness of risk factor control and the evolution of myocardial perfusion over time in patients with stable ischaemic heart disease. The aim of the study was to evaluate the changes in stress-rest myocardial perfusion in medically treated patients with stable chronic ischaemic heart disease and the relationship with risk factor control.
The study cohort included 174 consecutive patients (age 60 ± 9 years, 68 % men) undergoing stress-rest myocardial perfusion imaging (MPI) (study 1), who also underwent repeat evaluation (study 2) and who were clinically stable on medical therapy. Summed stress, rest and difference scores were calculated. According to the evolution of perfusion pattern from study 1 to study 2, patients were classified as improved, stable or worsened.
Study 2 was performed on average 2.7 years after study 1. Of the 174 patients, 47 (26.9 %), 53 (30.8 %) and 74 (42.5 %) were classified as stable, improved and worsened, respectively. A significant trend was observed between the number of risk factors at the time of study 1 and worsening of myocardial perfusion (24 % of patients with zero or one risk factor showed worsening, 31 % with two, and 59 % with three or more; p = 0.03). Moreover, patients with worsened perfusion had a higher number of poorly controlled risk factors.
Despite medical therapy and clinical stability, myocardial perfusion worsened in 42.5 % of patients. The risk profile was reclassified in half of the patients. Worsening occurred more frequently in patients with three or more risk factors at the time of study 1 and in those with poorly controlled risk factors at the time of study 2; in this subset of patients, even if clinically stable, reassessment after 2 years could be considered.
关于稳定型缺血性心脏病患者危险因素控制效果与心肌灌注随时间演变之间的相关性，现有数据较少。本研究的目的是评估接受药物治疗的稳定型慢性缺血性心脏病患者静息-负荷心肌灌注的变化及其与危险因素控制的关系。
研究队列包括174例连续接受静息-负荷心肌灌注成像（MPI）的患者（年龄60±9岁，68%为男性）（研究1），这些患者还接受了重复评估（研究2），且在药物治疗下临床稳定。计算负荷、静息和差值总分。根据从研究1到研究2灌注模式的演变，将患者分为改善、稳定或恶化。
研究2平均在研究1后2.7年进行。在174例患者中，分别有47例（26.9%）、53例（30.8%）和74例（42.5%）被分类为稳定、改善和恶化。研究1时的危险因素数量与心肌灌注恶化之间观察到显著趋势（0或1个危险因素的患者中有24%出现恶化，2个危险因素的患者中有31%，3个或更多危险因素的患者中有59%；p = 0.03）。此外，灌注恶化的患者有更多未得到良好控制的危险因素。
尽管进行了药物治疗且临床稳定，但42.5%的患者心肌灌注仍恶化。一半患者的风险状况被重新分类。在研究1时有3个或更多危险因素以及在研究2时有未得到良好控制的危险因素的患者中，恶化情况更频繁出现；对于这部分患者，即使临床稳定，2年后也可考虑重新评估。
