终末期肾病患者的冠状动脉钙负担、颈动脉粥样硬化斑块负担和心肌血流：结合 PET/CT 和 3D 超声的非侵入性影像学研究。

Coronary artery calcium burden, carotid atherosclerotic plaque burden, and myocardial blood flow in patients with end-stage renal disease: A non-invasive imaging study combining PET/CT and 3D ultrasound.

机构信息

Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.

Department of Internal Medicine D, General Internal Medicine and Nephrology, University Hospital Münster, Münster, Germany.

出版信息

J Nucl Cardiol. 2021 Dec;28(6):2660-2670. doi: 10.1007/s12350-020-02080-w. Epub 2020 Mar 5.

DOI:10.1007/s12350-020-02080-w

PMID:32140994

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8709813/

Abstract

BACKGROUND

Imaging-based measures of atherosclerosis such as coronary artery calcium score (CACS) and coronary flow reserve (CFR) as well as carotid atherosclerotic plaque burden (cPB) are predictors of cardiovascular events in the general population. The objective of this study was to correlate CACS, cPB, myocardial blood flow (MBF), and CFR in patients with end-stage renal disease (ESRD).

METHODS AND RESULTS

39 patients (mean age 53 ± 12 years) with ESRD prior to kidney transplantation were enrolled. MBF and CFR were quantified at baseline and under hyperemia by N-NH-PET/CT. CACS was calculated from low-dose CT scans acquired for PET attenuation correction. cPB was assessed by 3D ultrasound. Uni- and multivariate regression analyses between these and clinical parameters were performed. Median follow-up time for clinical events was 4.4 years. Kaplan-Meier survival estimates with log-rank test were performed with regards to cardiovascular (CV) events and death of any cause. CACS and cPB were associated in ESRD patients (r = 0.48; p ≤ 0.01). While cPB correlated with age (r = 0.43; p < 0.01), CACS did not. MBF was negatively associated with age (r = 0.44; p < 0.01) and time on dialysis (r = 0.42; p < 0.01). There were negative correlations between MBF and CACS (r = - 0.62; p < 0.001) and between MBF and cPB (r = - 0.43; p < 0.01). Age and CACS were the strongest predictors for MBF. CFR was impaired (< 2.0) in eight patients who also presented with higher cPB and higher CACS compared to those with a CFR > 2.0 (p = 0.06 and p = 0.4). In contrast to MBF, there was neither a significant correlation between CFR and CACS (r = - 0.2; p = 0.91) nor between CFR and cPB (r = - 0.1; p = 0.55). CV event-free survival was associated with reduced CFR and MBF (p = 0.001 and p < 0.001) but not with cPB or CACS.

CONCLUSIONS

CACS, cPB, and MBF are associated in patients with ESRD. Atherosclerosis is earlier detected by MBF than by CFR. CV event-free survival is associated with impaired CFR and MBF.

摘要

背景

基于影像学的动脉粥样硬化指标，如冠状动脉钙评分（CACS）和冠状动脉血流储备（CFR）以及颈动脉粥样硬化斑块负担（cPB），是普通人群心血管事件的预测因子。本研究的目的是在终末期肾病（ESRD）患者中，对 CACS、cPB、心肌血流（MBF）和 CFR 进行相关性分析。

方法和结果

共纳入 39 名 ESRD 患者（平均年龄 53±12 岁），在接受肾移植前进行研究。通过 N-NH-PET/CT 在基线和充血状态下对 MBF 和 CFR 进行定量评估。通过低剂量 CT 扫描计算 CACS，用于 PET 衰减校正。通过 3D 超声评估 cPB。对这些参数与临床参数进行单变量和多变量回归分析。临床事件的中位随访时间为 4.4 年。通过对数秩检验对心血管（CV）事件和任何原因导致的死亡进行 Kaplan-Meier 生存估计。ESRD 患者的 CACS 和 cPB 之间存在相关性（r=0.48;p≤0.01）。尽管 cPB 与年龄呈正相关（r=0.43;p<0.01），但 CACS 却没有。MBF 与年龄（r=0.44;p<0.01）和透析时间（r=0.42;p<0.01）呈负相关。MBF 与 CACS 之间存在负相关（r=-0.62;p<0.001），MBF 与 cPB 之间也存在负相关（r=-0.43;p<0.01）。年龄和 CACS 是 MBF 的最强预测因子。与 CFR>2.0 的患者相比，CFR<2.0 的 8 名患者的 cPB 和 CACS 更高（p=0.06 和 p=0.4）。与 MBF 不同，CFR 与 CACS 之间（r=-0.2;p=0.91）和 CFR 与 cPB 之间（r=-0.1;p=0.55）均无显著相关性。无 CV 事件的生存与降低的 CFR 和 MBF 相关（p=0.001 和 p<0.001），但与 cPB 或 CACS 无关。