Caobelli Federico, Popescu Cristina E, Laudicella Riccardo, Comis Alessio, Pignata Salvatore A, Sara Roberto, Rossetti Claudio
Department of Nuclear Medicine, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
Nuclear Medicine Department, Niguarda Ca' Granda Hospital, Milan.
Nucl Med Commun. 2018 May;39(5):423-429. doi: 10.1097/MNM.0000000000000816.
Patients under hemodialysis (HD) have an increased risk of major adverse cardiac events (MACEs). In these patients, myocardial perfusion scintigraphy (MPS) provides useful prognostic information. Left ventricular mechanical dyssynchrony (LVD) has been proven to predict all-cause death in patients under HD. It remains unclear, whether the same prognostic value pertains also to the prediction of MACEs.
Ninety patients under HD (duration range: 2-216 months) with neither history nor symptoms of coronary artery disease at the time of MPS were retrospectively evaluated. All underwent clinical evaluation and MPS with dipyridamole stress test. MPS was reprocessed to derive left ventricular ejection fraction (EF), perfusion scores [summed stress score (SSS) and summed difference score (SDS)] and LVD (phase histogram bandwidth and phase SD).ResultsMACEs were reported in 10 (11.1%) patients as assessed at more than 2 years of follow-up (median 29 months). At univariate analysis, a correlation was demonstrated between MACEs and LVD (P<0.001), BMI (P=0.04), ECG changes during stress (P=0.03), dyspnea (P=0.02), SSS (P=0.04) and SDS (P=0.02). At stepwise multivariate analysis, only LVD (P<0.001), SSS (P=0.01) and SDS (P=0.001) were independent predictors of MACEs. No thresholds of SSS or SDS showed predictive value (P=0.79 for SSS ≥4, P=0.10 for SSS >8 and P=0.66 for SDS ≥2). At survival analysis, patients with LVD had a significantly shorter MACE-free survival (P<0.001). This predictive value held true even in patients with an unremarkable pattern of perfusion.
In asymptomatic patients without known coronary artery disease under HD, LVD is highly predictive of the onset of MACEs at more than 2 years of follow-up and provides incremental value over perfusion scores alone. A phase analysis on gated MPS should be routinely performed in these patients to yield useful prognostic information.
接受血液透析（HD）的患者发生主要不良心脏事件（MACE）的风险增加。在这些患者中，心肌灌注显像（MPS）可提供有用的预后信息。左心室机械性不同步（LVD）已被证明可预测HD患者的全因死亡。目前尚不清楚其对MACE的预测是否具有同样的预后价值。
对90例接受HD（透析时间范围：2 - 216个月）且在进行MPS时既无冠心病病史也无症状的患者进行回顾性评估。所有患者均接受临床评估及双嘧达莫负荷试验的MPS检查。对MPS进行再处理以得出左心室射血分数（EF）、灌注评分[总负荷评分（SSS）和总差异评分（SDS）]以及LVD（相位直方图带宽和相位标准差）。
在超过2年的随访（中位时间29个月）中，有10例（11.1%）患者发生MACE。单因素分析显示，MACE与LVD（P<0.001）、体重指数（BMI，P = 0.04）、负荷时心电图变化（P = 0.03）、呼吸困难（P = 0.02）、SSS（P = 0.04）和SDS（P = 0.02）之间存在相关性。逐步多因素分析显示，只有LVD（P<0.001）、SSS（P = 0.01）和SDS（P = 0.001）是MACE的独立预测因素。SSS或SDS的任何阈值均未显示出预测价值（SSS≥4时P = 0.79，SSS>8时P = 0.10，SDS≥2时P = 0.66）。生存分析显示，LVD患者的无MACE生存期显著缩短（P<0.001）。即使在灌注模式无异常表现的患者中，这种预测价值依然成立。
在无症状且无已知冠心病的HD患者中，LVD对超过2年随访期内MACE的发生具有高度预测性，且相对于单独的灌注评分具有额外价值。这些患者应常规进行门控MPS的相位分析以获取有用的预后信息。
