Lu X, Nie B B, Yun M K, Zhu Z W, Xie X F, Mou T T, Mi H Z, Wei Y X, Li X, Shan B C, Zhang X L
Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Mar 24;48(3):211-216. doi: 10.3760/cma.j.cn112148-20190513-00245.
To evaluate the relationship between the brain glucose metabolism and left ventricular function parameters, and to explore the cerebral glucose metabolism reduction regions in patients with ischemic heart disease (IHD). A total of 110 consecutive IHD patients who underwent gated (99)Tc(m)-sestamibi (MIBI) SPECT/CT myocardial perfusion imaging, gated (18)F-fluorodeoxyglucose (FDG) PET/CT myocardial and brain glucose metabolic imaging within three days in Beijing Anzhen Hospital from April 2016 to October 2017, were enrolled in this study. Left ventricular functional parameters of SPECT/CT and PET/CT including end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) were analyzed by QGS software. Viable myocardium and myocardial infarction region were determined by 17-segment and 5 score system, and the ratio of viable myocardium and scar myocardium was calculated. According to the range of viable myocardium, the patients were divided into viable myocardium<10% group (n=44), viable myocardium 10%-<20% group (=36) and viable myocardium≥20% group (=30). Pearson correlation analysis was used to analyze the correlation between the range of viable myocardium and scar myocardium and the level of cerebral glucose metabolism. Brain glucose metabolism determined by the mean of standardized uptake value (SUV(mean)) was analyzed by SPM. The ratio of SUV(mean) in whole brain and SUV(mean) in cerebellum were calculated, namely taget/background ratio (TBR). Differences in cerebral glucose metabolism among various groups were analyzed by SPM. There were 101 males, and age was (57±10) years in this cohort. The extent of viable myocardium and the extent of scar, LVEF evaluated by SPECT/CT and PET/CT were significantly correlated with TBR (=0.280, =-0.329, =0.188, =0.215 respectively,all <0.05). TBR value was significantly lower in viable myocardium<10% group, compared with viable myocardium 10%-<20% group (1.25±0.97 vs. 1.32±0.17, <0.05) and viable myocardium≥20% group (1.25±0.97 vs. 1.34±0.16, <0.05). Furthermore, in comparison with viable myocardium≥20% group, the hypo-metabolic regions of viable myocardium<10% group were located in the precuneus, frontal lobe, postcentral gyrus, parietal lobe, temporal lobe, and so on. There is a correlation between impaired left ventricular function and brain glucose metabolism in IHD patients. In IHD patients with low myocardial viability, the level of glucose metabolism in the whole brain is decreased, especially in the brain functional areas related to cognitive function.
评估脑葡萄糖代谢与左心室功能参数之间的关系，并探索缺血性心脏病（IHD）患者脑葡萄糖代谢降低区域。选取2016年4月至2017年10月在北京安贞医院连续接受门控（99）锝（m）-甲氧基异丁基异腈（MIBI）SPECT/CT心肌灌注成像、门控（18）氟脱氧葡萄糖（FDG）PET/CT心肌和脑葡萄糖代谢成像的110例IHD患者纳入本研究。通过QGS软件分析SPECT/CT和PET/CT的左心室功能参数，包括舒张末期容积（EDV）、收缩末期容积（ESV）和左心室射血分数（LVEF）。采用17节段和5分制确定存活心肌和心肌梗死区域，并计算存活心肌与瘢痕心肌的比例。根据存活心肌范围，将患者分为存活心肌<10%组（n = 44）、存活心肌10%-<20%组（n = 36）和存活心肌≥20%组（n = 30）。采用Pearson相关分析分析存活心肌和瘢痕心肌范围与脑葡萄糖代谢水平之间的相关性。通过统计参数映射（SPM）分析由标准化摄取值（SUV(mean)）均值确定的脑葡萄糖代谢。计算全脑SUV(mean)与小脑SUV(mean)的比值，即目标/背景比值（TBR）。采用SPM分析各组间脑葡萄糖代谢的差异。该队列中有101名男性，年龄为（57±10）岁。SPECT/CT和PET/CT评估的存活心肌范围、瘢痕范围、LVEF与TBR均显著相关（分别为r = 0.280、r = -0.329、r = 0.188、r = 0.215，均P < 0.05）。存活心肌<10%组的TBR值显著低于存活心肌10%-<20%组（1.25±0.97 vs. 1.32±0.17，P < 0.05）和存活心肌≥20%组（1.25±0.97 vs. 1.34±0.16，P < 0.05）。此外，与存活心肌≥20%组相比，存活心肌<10%组的代谢减低区域位于楔前叶、额叶、中央后回、顶叶、颞叶等。IHD患者左心室功能受损与脑葡萄糖代谢之间存在相关性。在心肌存活能力低的IHD患者中，全脑葡萄糖代谢水平降低，尤其是在与认知功能相关的脑功能区。
