门控 SPECT 心肌灌注显像评估缺血性心力衰竭患者存活能力时，与单纯灌注相比，心肌节段运动和增厚的增量价值。
Incremental value of myocardial wall motion and thickening to perfusion alone by gated SPECT myocardial perfusion imaging for viability assessment in patients with ischemic heart failure.
机构信息
Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, Jiangsu, China.
Department of Nuclear Medicine, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China.
出版信息
J Nucl Cardiol. 2021 Dec;28(6):2545-2556. doi: 10.1007/s12350-020-02040-4. Epub 2020 Feb 14.
PURPOSE
The objective of this study was to assess the incremental value of myocardial wall motion and thickening compared with perfusion alone obtained from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in diagnosing myocardial viability in patients with ischemic heart failure.
METHODS
Eighty-three consecutive patients with ischemic heart failure who underwent both Tc-MIBI gated SPECT MPI and F-FDG positron emission tomography (PET) myocardial metabolic imaging were retrospectively enrolled. SPECT/PET myocardial viability was defined as the reference standard. Segmental myocardial perfusion, wall motion, and thickening were measured by an automated algorithm from gated SPECT MPI. Univariate and stepwise multivariate analysis were conducted to establish an optimal multivariate model for predicting hibernating myocardium and scar.
RESULTS
Among the 1411 segments evaluated, 774 segments had normal perfusion and 637 segments had decreased perfusion. The latter were classified by F-FDG PET into 338 hibernating segments and 299 scarred segments. The multivariate regression analysis showed that the model that combined myocardial perfusion uptake with wall motion and thickening scores had the optimal predictive efficiency to distinguish hibernating myocardium from scar in the segments with decreased perfusion. The model had the largest C-statistic (0.753 vs 0.666, P < 0.0001), and the global chi-square was increased from 53.281 to 111.234 when compared with perfusion alone (P < 0.001).
CONCLUSIONS
Assessment of myocardial wall motion and thickening in addition to conventional perfusion uptake in the segments with decreased perfusion enables better differentiation of hibernating myocardium from scar in patients with ischemic heart failure. Considering wide availability and high cost-effectiveness, regional myocardial function integrated with perfusion on gated SPECT MPI has great promise to become a clinical tool in the assessment of myocardial viability.
目的
本研究旨在评估门控单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）心肌运动和增厚与灌注单独评估在诊断缺血性心力衰竭患者心肌存活能力方面的增量价值。
方法
回顾性纳入 83 例连续接受 Tc-MIBI 门控 SPECT MPI 和 F-FDG 正电子发射断层扫描（PET）心肌代谢成像的缺血性心力衰竭患者。SPECT/PET 心肌存活能力定义为参考标准。通过门控 SPECT MPI 的自动算法测量节段性心肌灌注、心肌运动和心肌增厚。进行单变量和逐步多变量分析，以建立预测冬眠心肌和瘢痕的最佳多变量模型。
结果
在评估的 1411 个节段中，774 个节段灌注正常，637 个节段灌注减少。后者根据 F-FDG PET 分为 338 个冬眠节段和 299 个瘢痕节段。多变量回归分析显示，将心肌灌注摄取与心肌运动和心肌增厚评分相结合的模型对区分灌注减少节段中的冬眠心肌和瘢痕具有最佳的预测效率。该模型具有最大的 C 统计量（0.753 比 0.666，P < 0.0001），与仅灌注相比，全局卡方从 53.281 增加到 111.234（P < 0.001）。
结论
在灌注减少的节段中，除了常规灌注摄取外，评估心肌运动和增厚有助于更好地区分冬眠心肌和瘢痕，在缺血性心力衰竭患者中。考虑到广泛的可用性和高成本效益，门控 SPECT MPI 上的灌注与局部心肌功能的整合具有成为评估心肌存活能力的临床工具的巨大潜力。
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