心肌灌注闪烁显像与超声心动图测量左心室射血分数之间一致性的性别差异。
Sex differences in the agreement between left ventricular ejection fraction measured by myocardial perfusion scintigraphy and by echocardiography.
作者信息
Jaker Sams, Burgan Amjad, Prakash Vineet, Birkinshaw Alexander, Moosai Kishan, Jacques Adam, Fluck David, MacGregor Mark, Lazariashvili Otar, Sharma Pankaj, Fry Christopher H, Han Thang S
机构信息
Department of Radiology, Ashford & St Peter's Foundation Trust, Chertsey, UK.
Department of Cardiology, Ashford & St Peter's Foundation Trust, Chertsey, UK.
出版信息
JRSM Cardiovasc Dis. 2020 Mar 24;9:2048004020915393. doi: 10.1177/2048004020915393. eCollection 2020 Jan-Dec.
BACKGROUND
Left ventricular ejection fraction (LVEF) is generally measured by echocardiography but is increasingly available with myocardial perfusion scintigraphy. With myocardial perfusion scintigraphy, the threshold of LVEF below which there is a risk for myocardial infarct or sudden cardiac death is higher for women (51%) than for men (43%). We tested the hypothesis that such a sex difference may also occur with echocardiography and myocardial perfusion scintigraphy.
METHODS
Four hundred and four men, mean age = 67.7 ± SD = 12.3 yr; 339 women, 67.7 ± 11.7 yr had separate myocardial perfusion scintigraphy and echocardiography examinations within six months. A subset of 327 of these patients (181 men, 68.8 ± 12.1 yr; 146 women, 66.4 ± 12.1 yr) had examinations within one month and were additionally analysed as this sub-group. Myocardial perfusion scintigraphy and echocardiography were used to measure LVEF at rest and their agreement (neither considered as a reference method) was assessed by Bland-Altman plots: LVEF difference (myocardial perfusion scintigraphy minus echocardiography ) against average LVEF ( ).
RESULTS
Of patients who had myocardial perfusion scintigraphy and echocardiography performed within six months, mean LVEF difference = +1.1% (95% limits of agreement: -19.3 to +21.6) in men but +10.9% (-10.7 to +32.5) in women. LVEF difference diverged from zero marginally in men (mean difference = +1.1, 95%CI = +0.1 to +2.1, = 0.028) but more in women (+10.9, +9.8 to +12.1, < 0.001). The LVEF difference correlated with average LVEF itself in both men ( = 0.305, < 0.001) and women ( = 0.361, < 0.001), and with age in women ( = 0.117, = 0.031). Similar results were observed for the subset.
CONCLUSIONS
Caution should be taken when interpreting LVEF measured by different techniques due to their wide limits of agreement and systematic bias, more markedly in women.
背景
左心室射血分数（LVEF）通常通过超声心动图测量，但心肌灌注闪烁扫描也越来越多地用于测量该指标。采用心肌灌注闪烁扫描时，发生心肌梗死或心源性猝死风险的LVEF阈值在女性（51%）中高于男性（43%）。我们检验了这样一种假设，即超声心动图和心肌灌注闪烁扫描测量时也可能存在这种性别差异。
方法
404名男性，平均年龄 = 67.7 ± 标准差 = 12.3岁；339名女性，67.7 ± 11.7岁，在6个月内分别进行了心肌灌注闪烁扫描和超声心动图检查。其中327名患者（181名男性，68.8 ± 12.1岁；146名女性，66.4 ± 12.1岁）在1个月内进行了检查，并作为该亚组进行了额外分析。采用心肌灌注闪烁扫描和超声心动图测量静息状态下的LVEF，并通过Bland-Altman图评估二者的一致性（均不作为参考方法）：LVEF差值（心肌灌注闪烁扫描测量值减去超声心动图测量值）相对于平均LVEF（ ）。
结果
在6个月内同时进行心肌灌注闪烁扫描和超声心动图检查的患者中，男性的平均LVEF差值 = +1.1%（一致性界限95%：-19.3至+21.6），而女性为+10.9%（-10.7至+32.5）。男性的LVEF差值与零值略有偏离（平均差值 = +1.1，95%置信区间 = +0.1至+2.1，P = 0.028），而女性偏离更明显（+10.9，+9.8至+12.1，P < 0.001）。LVEF差值在男性（r = 0.305，P < 0.001）和女性（r = 0.361，P < 0.001）中均与平均LVEF本身相关，在女性中还与年龄相关（r = 0.117，P = 0.031）。该亚组观察到了类似结果。
结论
由于不同技术测量LVEF时一致性界限较宽且存在系统偏差，尤其是在女性中更明显，因此在解释测量结果时应谨慎。
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