正电子发射断层扫描心肌灌注成像评估的心肌血流储备可识别出早期血运重建可获益的生存患者。
Myocardial blood flow reserve assessed by positron emission tomography myocardial perfusion imaging identifies patients with a survival benefit from early revascularization.
机构信息
Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.
Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA.
出版信息
Eur Heart J. 2020 Feb 1;41(6):759-768. doi: 10.1093/eurheartj/ehz389.
AIMS
Positron emission tomography (PET) myocardial perfusion imaging (MPI) can non-invasively measure myocardial blood flow reserve (MBFR). We aimed to examine whether MBFR identifies patients with a survival benefit after revascularization, helping to guide post-test management.
METHODS AND RESULTS
We examined all-cause mortality in 12 594 consecutive patients undergoing Rb82 rest/stress PET MPI from January 2010 to December 2016, after excluding those with cardiomyopathy, prior coronary artery bypass surgery (CABG), and missing MBFR. Myocardial blood flow reserve was calculated as the ratio of stress to rest absolute myocardial blood flow. A Cox model adjusted for patient and test characteristics, early revascularization (percutaneous coronary intervention or CABG ≤90 days of MPI), and the interaction between MBFR and early revascularization was developed to identify predictors of all-cause mortality. After a median follow-up of 3.2 years, 897 patients (7.1%) underwent early revascularization and 1699 patients (13.5%) died. Ischaemia was present in 4051 (32.3%) patients, with 1413 (11.2%) having ≥10% ischaemia. Mean MBFR was 2.0 ± 1.3, with MBFR <1.8 in 4836 (38.5%). After multivariable adjustment, every 0.1 unit decrease in MBFR was associated with 9% greater hazard of all-cause death (hazard ratio 1.09, 95% confidence interval 1.08-1.10; P < 0.001). There was a significant interaction between MBFR and early revascularization (P < 0.001); such that patients with MBFR ≤1.8 had a survival benefit with early revascularization, regardless of type of revascularization or level of ischaemia.
CONCLUSION
Myocardial blood flow reserve on PET MPI is associated with all-cause mortality and can identify patients who receive a survival benefit with early revascularization compared to medical therapy. This may be used to guide revascularization, and prospective validation is needed.
目的
正电子发射断层扫描（PET）心肌灌注成像（MPI）可无创测量心肌血流储备（MBFR）。我们旨在检验 MBFR 是否能识别出血运重建后具有生存获益的患者，以帮助指导检测后的管理。
方法和结果
我们对 2010 年 1 月至 2016 年 12 月期间连续 12594 例接受 Rb82 静息/负荷 PET MPI 的患者进行了全因死亡率的检查，这些患者排除了心肌病、先前的冠状动脉旁路移植术（CABG）和 MBFR 缺失。心肌血流储备通过应激与静息绝对心肌血流之比计算。采用 Cox 模型，调整患者和检查特征、早期血运重建（经皮冠状动脉介入治疗或 CABG≤90 天 MPI）以及 MBFR 与早期血运重建之间的相互作用，以确定全因死亡率的预测因素。中位随访 3.2 年后，897 例（7.1%）患者进行了早期血运重建，1699 例（13.5%）患者死亡。4051 例（32.3%）患者存在缺血，1413 例（11.2%）患者存在≥10%的缺血。平均 MBFR 为 2.0±1.3，MBFR＜1.8 的患者有 4836 例（38.5%）。经多变量调整后，MBFR 每降低 0.1 单位，全因死亡风险增加 9%（危险比 1.09，95%置信区间 1.08-1.10；P＜0.001）。MBFR 与早期血运重建之间存在显著的相互作用（P＜0.001）；即 MBFR≤1.8 的患者与单纯药物治疗相比，早期血运重建具有生存获益。这可能用于指导血运重建，需要前瞻性验证。
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