在雷卡弹珠酸应激固态 SPECT-MPI 中，早期左心室射血分数储备的预后价值。

Prognostic value of early left ventricular ejection fraction reserve during regadenoson stress solid-state SPECT-MPI.

机构信息

Department of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Metro 203, Los Angeles, CA, 90048, USA.

Oregon Heart and Vascular Institute, Sacred Heart Medical Center, 3311 Riverbend Drive, Springfield, OR, 97477, USA.

出版信息

J Nucl Cardiol. 2022 Jun;29(3):1219-1230. doi: 10.1007/s12350-020-02420-w. Epub 2021 Jan 3.

DOI:10.1007/s12350-020-02420-w

PMID:33389643

Abstract

BACKGROUND

We hypothesized early post-stress left ventricular ejection fraction reserve (EFR) on solid-state-SPECT is associated with major cardiac adverse events (MACE).

METHODS

151 patients (70 ± 12 years, male 50%) undergoing same-day rest/regadenoson stress Tc-sestamibi solid-state SPECT were followed for MACE. Rest imaging was performed in the upright and supine positions. Early stress imaging was started 2 minutes after the regadenoson injection in the supine position and followed by late stress acquisition in the upright position. Total perfusion deficit (TPD) and functional parameters were quantified automatically. EFR, ∆end-diastolic volume (EDV), and end-systolic volume (ESV) were calculated as the difference between stress and rest values in the same position. EFR < 0%, ∆EDV ≥ 5 ml, or ∆ESV ≥ 5 ml was defined as abnormal.

RESULTS

During the follow-up (mean 3.2 years), 28 MACE occurred (19%). In Kaplan-Meier analysis, there was a significantly decreased event-free survival in patients with early EFR < 0% (P = 0.004). Similarly, there was a decreased event-free survival in patients with ∆ESV ≥ 5 ml at early stress (P = 0.003). However, EFR, ∆EDV, and ∆ESV at late stress were not associated with MACE-free survival. Cox proportional hazards model adjusting for clinical information and stress TPD demonstrated that EFR, ∆EDV, and ∆ESV at early stress were significantly associated with MACE (P < 0.05 for all).

CONCLUSIONS

Reduced early post-stress EFR on vasodilator stress solid-state SPECT is associated with MACE.

摘要

背景

我们假设应激后即刻左心室射血分数储备（EFR）与主要心脏不良事件（MACE）相关。

方法

151 名患者（70±12 岁，男性 50%）行同日静息/负荷腺苷 Tc- sestamibi 单光子发射计算机断层扫描（SPECT）检查，随访 MACE 发生情况。静息成像采用仰卧位和直立位。仰卧位静脉注射负荷药物后 2 分钟开始早期负荷成像，随后在直立位进行晚期负荷采集。采用自动方法定量计算总灌注缺损（TPD）和功能参数。EFR、舒张末期容积（EDV）差和收缩末期容积（ESV）差分别定义为同一体位下的负荷值与静息值之差。EFR＜0%、△EDV≥5ml 或△ESV≥5ml 定义为异常。

结果

随访期间（平均 3.2 年）发生 28 例 MACE（19%）。Kaplan-Meier 分析显示，早期 EFR＜0%的患者无事件生存率显著降低（P=0.004）。同样，早期负荷时△ESV≥5ml 的患者无事件生存率也降低（P=0.003）。然而，晚期应激的 EFR、△EDV 和△ESV 与 MACE 无事件生存率无关。调整临床信息和应激 TPD 的 Cox 比例风险模型显示，早期应激的 EFR、△EDV 和△ESV 与 MACE 显著相关（所有 P＜0.05）。