I-MIBG 心肌闪烁显像和心率变异性对射血分数保留心力衰竭患者的预后价值。
Prognostic values of I-MIBG myocardial scintigraphy and heart rate variability in patients with heart failure with preserved ejection fraction.
机构信息
Department of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, 6-11-1, Omorinishi, Ota-ward, Tokyo, 143-8541, Japan.
Department of Radiology, Toho University Faculty of Medicine, Tokyo, Japan.
出版信息
J Nucl Cardiol. 2020 Jun;27(3):833-842. doi: 10.1007/s12350-018-01494-x. Epub 2018 Nov 1.
BACKGROUND
The aim of this study was to evaluate the prognostic values of sympathetic nerve system using I-MIBG myocardial scintigraphy and using Holter electrocardiogram (ECG) in patients with heart failure with preserved ejection fraction (HFpEF).
METHODS AND RESULTS
Among 403 consecutive patients with stable HF who underwent I-MIBG myocardial scintigraphy and Holter ECG, we identified 133 patients (64 ± 16 years) who had preserved ejection fraction (≥ 50%) by echocardiography. Multivariate Cox model was used to assess if washout rate (WR) by I-MIBG scintigraphy and very low frequency power (VLFP) by Holter ECG was associated with major adverse cardiovascular events (MACE). During a mean follow-up of 5.4 ± 4.1 years, 39 MACE occurred. The lower nighttime VLFP (HR 3.29, 95% CI 1.56 to 6.92) and higher WR (HR 4.01, 95% CI 1.63 to 9.88) were the significant prognostic factors for MACE. As compared to high nighttime VLFP and low WR group, MACE risk was significantly the highest in the low nighttime VLFP and high WR group (HR 40.832; 95% CI 5.378 to 310.012, P < 0.001).
CONCLUSION
This study demonstrated that the nighttime VLFP adding to WR could be a potential prognostic value among patients with HFpEF.
背景
本研究旨在评估使用 I-MIBG 心肌闪烁显像和动态心电图（ECG）评估射血分数保留的心力衰竭（HFpEF）患者交感神经系统的预后价值。
方法和结果
在连续 403 例接受 I-MIBG 心肌闪烁显像和动态心电图的稳定型 HF 患者中，我们确定了 133 例（64±16 岁）通过超声心动图检查射血分数保留（≥50%）的患者。多变量 Cox 模型用于评估 I-MIBG 闪烁显像的洗脱率（WR）和动态心电图的极低频功率（VLFP）是否与主要不良心血管事件（MACE）相关。在平均 5.4±4.1 年的随访期间，发生了 39 次 MACE。夜间 VLFP 越低（HR 3.29，95%CI 1.56 至 6.92）和 WR 越高（HR 4.01，95%CI 1.63 至 9.88）是 MACE 的显著预后因素。与夜间高 VLFP 和低 WR 组相比，夜间低 VLFP 和高 WR 组的 MACE 风险显著最高（HR 40.832；95%CI 5.378 至 310.012，P<0.001）。
结论
本研究表明，WR 中添加夜间 VLFP 可能是 HFpEF 患者潜在的预后价值。
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