正电子发射断层扫描显示心肌血流储备减少可预测心脏移植后的心血管事件。
Reduced Myocardial Flow Reserve by Positron Emission Tomography Predicts Cardiovascular Events After Cardiac Transplantation.
机构信息
Division of Cardiovascular Medicine, Department of Internal Medicine (M.C.K., J.J.L., R.L.W., M.G., S.L.H., J.R.C., K.D.A., M.M.C., T.M.K., V.L.M.)
Division of Cardiovascular Medicine, Department of Internal Medicine (M.C.K., J.J.L., R.L.W., M.G., S.L.H., J.R.C., K.D.A., M.M.C., T.M.K., V.L.M.).
出版信息
Circ Heart Fail. 2018 Jun;11(6):e004473. doi: 10.1161/CIRCHEARTFAILURE.117.004473.
BACKGROUND
We evaluated the diagnostic and prognostic value of quantification of myocardial flow reserve (MFR) with positron emission tomography (PET) in orthotopic heart transplant patients.
METHODS AND RESULTS
We retrospectively identified orthotopic heart transplant patients who underwent rubidium-82 cardiac PET imaging. The primary outcome was the composite of cardiovascular death, acute coronary syndrome, coronary revascularization, and heart failure hospitalization. Cox regression was used to evaluate the association of MFR with the primary outcome. The relationship of MFR and cardiac allograft vasculopathy severity in patients with angiography within 1 year of PET imaging was assessed using Spearman rank correlation and logistic regression. A total of 117 patients (median age, 60 years; 71% men) were identified. Twenty-one of 62 patients (34%) who underwent angiography before PET had cardiac allograft vasculopathy. The median time from orthotopic heart transplant to PET imaging was 6.4 years (median global MFR, 2.31). After a median of 1.4 years, 22 patients (19%) experienced the primary outcome. On an unadjusted basis, global MFR (hazard ratio, 0.22 per unit increase; 95% confidence interval, 0.09-0.50; <0.001) and stress myocardial blood flow (hazard ratio, 0.48 per unit increase; 95% confidence interval, 0.29-0.79; =0.004) were associated with the primary outcome. Decreased MFR independently predicted the primary outcome after adjustment for other variables. In 42 patients who underwent angiography within 12 months of PET, MFR and stress myocardial blood flow were associated with moderate-severe cardiac allograft vasculopathy (International Society of Heart and Lung Transplantation grade 2-3).
CONCLUSIONS
MFR assessed by cardiac rubidium-82 PET imaging is a predictor of cardiovascular events after orthotopic heart transplant and is associated with cardiac allograft vasculopathy severity.
背景
我们评估了正电子发射断层扫描（PET）心肌血流储备（MFR）定量在原位心脏移植患者中的诊断和预后价值。
方法和结果
我们回顾性地确定了接受放射性铷-82心脏 PET 成像的原位心脏移植患者。主要结局是心血管死亡、急性冠状动脉综合征、冠状动脉血运重建和心力衰竭住院的复合事件。Cox 回归用于评估 MFR 与主要结局的关系。使用 Spearman 秩相关和逻辑回归评估了 PET 成像后 1 年内接受血管造影的患者中 MFR 与心脏移植物血管病严重程度的关系。共确定了 117 例患者（中位年龄 60 岁；71%为男性）。62 例接受血管造影的患者中有 21 例（34%）有心脏移植物血管病。从原位心脏移植到 PET 成像的中位时间为 6.4 年（中位全因 MFR 为 2.31）。在中位 1.4 年后，22 例患者（19%）发生了主要结局。在未调整的基础上，全因 MFR（风险比，每单位增加 0.22；95%置信区间，0.09-0.50；<0.001）和应激心肌血流（风险比，每单位增加 0.48；95%置信区间，0.29-0.79；=0.004）与主要结局相关。在调整其他变量后，MFR 降低独立预测了主要结局。在 PET 后 12 个月内接受血管造影的 42 例患者中，MFR 和应激心肌血流与中度重度心脏移植物血管病（国际心肺移植学会 2-3 级）相关。
结论
放射性铷-82 心脏 PET 成像评估的 MFR 是原位心脏移植后心血管事件的预测因子，与心脏移植物血管病严重程度相关。
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