锝-3 标记白细胞 SPECT/CT 对心脏器械相关感染性心内膜炎的预后价值。
The Prognostic Value of mTc-HMPAO-Labeled Leucocyte SPECT/CT in Cardiac Device-Related Infective Endocarditis.
机构信息
Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
出版信息
JACC Cardiovasc Imaging. 2020 Aug;13(8):1739-1751. doi: 10.1016/j.jcmg.2020.01.025. Epub 2020 Apr 15.
OBJECTIVES
This was a prospective, single-center study designed to assess the prognostic value of the hybrid technique of single photon emission tomography and computed tomography with the application of technetiumm-hexamethylpropyleneamine oxime-labelled autologous leukocytes (mTc-HMPAO-SPECT/CT) in patients with cardiac device-related infective endocarditis (CDRIE).
BACKGROUND
CDRIE entails the risk of complications and an increase in mortality rates, both in-hospital and long-term. The prognostic value of mTc-HMPAO-SPECT/CT in the course of CDRIE has not been evaluated so far.
METHODS
The project enrolled 103 consecutive patients with suspected CDRIE, all of whom underwent Tc-HMPAO-SPECT/CT. The resulting scans were then classified as positive if the presence of abnormal tracer uptake involving cardiac and intravascular sections of the device electrodes was found. Patients were prospectively observed for a mean time of 17.48 ± 11.9 months. All-cause mortality, in-hospital mortality, and complete hardware removal were assessed, followed by a composite endpoint including complications, namely embolic events, new onset heart failure, uncontrolled infection, renal replacement therapy, reoperation, new heart rhythm, and conduction disturbances.
RESULTS
In the analysis, despite a noticeable trend, all-cause mortality rates were not found to be statistically significantly higher among the 35 patients who registered positive results using Tc-HMPAO-SPECT/CT for CDRIE (group 1) than among the 68 patients from group 2 whose Tc-HMPAO-SPECT/CT results were negative (20% vs. 10.3%, respectively; p = 0.14). However, group 1 did present higher in-hospital mortality (11.4% vs. 0%, respectively; odds ratio: 19.6; 95% confidence interval [CI]: 1.02 to 374.70), an increased rate of complications (43% vs. 9%, respectively; hazard ratio [HR]: 5.9; 95% CI: 2.27 to 15.20), and underwent hardware removal more frequently (57% vs. 16%, respectively; HR: 4.3; 95% CI: 2.07 to 19.08).
CONCLUSIONS
In patients with suspected CDRIE, positive Tc-HMPAO-SPECT/CT results were associated with increased rates of in-hospital mortality and complications.
目的
本前瞻性单中心研究旨在评估锝-99m-六甲基丙烯胺肟标记自体白细胞（mTc-HMPAO-SPECT/CT）混合技术在心脏装置相关感染性心内膜炎（CDRIE）患者中的预后价值。
背景
CDRIE 存在并发症风险，会增加住院和长期死亡率。目前尚未评估 mTc-HMPAO-SPECT/CT 在 CDRIE 病程中的预后价值。
方法
该项目纳入了 103 例疑似 CDRIE 的连续患者，所有患者均接受了 Tc-HMPAO-SPECT/CT 检查。如果发现心脏和装置电极血管段存在异常示踪剂摄取，则将扫描结果分类为阳性。前瞻性观察患者平均时间为 17.48±11.9 个月。评估全因死亡率、住院死亡率和完全去除硬件，并评估包括并发症（即栓塞事件、新发心力衰竭、感染失控、肾脏替代治疗、再次手术、新发心律失常和传导障碍）在内的复合终点。
结果
在分析中，尽管有明显的趋势，但 Tc-HMPAO-SPECT/CT 对 CDRIE 结果阳性的 35 例患者（第 1 组）的全因死亡率并未显著高于 Tc-HMPAO-SPECT/CT 结果阴性的 68 例患者（第 2 组）（分别为 20%和 10.3%；p=0.14）。然而，第 1 组的住院死亡率更高（分别为 11.4%和 0%；比值比：19.6；95%置信区间 [CI]：1.02 至 374.70），并发症发生率更高（分别为 43%和 9%；风险比 [HR]：5.9；95%CI：2.27 至 15.20），且更频繁地去除硬件（分别为 57%和 16%；HR：4.3；95%CI：2.07 至 19.08）。
结论
在疑似 CDRIE 的患者中，Tc-HMPAO-SPECT/CT 阳性结果与住院死亡率和并发症发生率增加有关。
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