Nuclear Medicine Department, Grenoble-Alpes University Hospital, Grenoble, France.
Radiopharmaceutiques Biocliniques, UMR UGA-INSERM U1039, Grenoble, France.
Eur J Nucl Med Mol Imaging. 2021 Jun;48(6):1813-1821. doi: 10.1007/s00259-020-05110-4. Epub 2020 Nov 20.
Risk stratification of patients with type 2 diabetes mellitus (T2D) remains suboptimal. We hypothesized that myocardial perfusion entropy (MPE) quantified from SPECT myocardial perfusion images may provide incremental prognostic value in T2D patients independently from myocardial ischemia.
T2D patients with very high and high cardiovascular risk were prospectively included (n = 166, 65 ± 12 years). Stress perfusion defect was quantified by visual evaluation of SPECT MPI. SPECT MPI was also used for the quantification of rest and stress MPE. The primary end point was major adverse cardiac events (MACEs) defined as cardiac death, myocardial infarction (MI), and myocardial revascularization > 3 months after SPECT.
Forty-four MACEs were observed during a 4.6-year median follow-up. Significant differences in stress MPE were observed between patients with and without MACEs (4.19 ± 0.46 vs. 3.93 ± 0.40; P ≤ .01). By Kaplan-Meier analysis, the risk of MACEs was significantly higher in patients with higher stress MPE (log-rank P ≤ 01). Stress MPE and stress perfusion defect (SSS ≥ 4) were significantly associated with the risk of MACEs (hazard ratio 2.77 and 2.06, respectively, P < .05 for both) after adjustment for clinical and imaging risk predictors as identified from preliminary univariate analysis. MPE demonstrated incremental prognostic value over clinical risk factors, stress test EKG and SSS as evidenced by nested models showing improved Akaike information criterion (AIC), reclassification (global continuous net reclassification improvement [NRI]: 63), global integrated discrimination improvement (IDI: 6%), and discrimination (change in c-statistic: 0.66 vs 0.74).
Stress MPE provided independent and incremental prognostic information for the prediction of MACEs in diabetic patients.
NCT02316054 (12/12/2014).
2 型糖尿病（T2D）患者的风险分层仍然不理想。我们假设从 SPECT 心肌灌注图像中定量的心肌灌注熵（MPE）可能会提供独立于心肌缺血的 T2D 患者的增量预后价值。
前瞻性纳入具有极高和高心血管风险的 T2D 患者（n=166，65±12 岁）。通过 SPECT MPI 的视觉评估定量应激灌注缺陷。SPECT MPI 还用于定量静息和应激 MPE。主要终点是重大不良心脏事件（MACEs），定义为 SPECT 后 3 个月以上的心脏死亡、心肌梗死（MI）和血运重建。
在 4.6 年的中位随访期间，观察到 44 例 MACEs。在有和没有 MACEs 的患者之间，观察到应激 MPE 存在显著差异（4.19±0.46 与 3.93±0.40；P≤0.01）。通过 Kaplan-Meier 分析，在 MPE 较高的患者中，MACEs 的风险明显更高（对数秩 P≤0.01）。应激 MPE 和应激灌注缺陷（SSS≥4）与 MACEs 的风险显著相关（危险比分别为 2.77 和 2.06，两者均 P<0.05），校正初步单因素分析确定的临床和影像风险预测因子后。MPE 显示出比临床危险因素、应激试验心电图和 SSS 更高的增量预后价值，这一点从嵌套模型中得到证明，这些模型显示出改进的 Akaike 信息准则（AIC）、重新分类（全局连续净重新分类改善[NRI]：63%）、全局综合区分改善（IDI：6%）和区分（c 统计量的变化：0.66 与 0.74）。
应激 MPE 为糖尿病患者 MACEs 的预测提供了独立的增量预后信息。
NCT02316054（12/12/2014）。
