局灶性心肌锝 99m 甲氧基异丁基异腈摄取严重减少表明扩张型心肌病患者心室不可逆。

Focal severe decrease in myocardial technetium-99 m sestamibi uptake indicates ventricular irreversibility in patients with dilated cardiomyopathy.

机构信息

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan.

出版信息

Ann Nucl Med. 2021 Aug;35(8):881-888. doi: 10.1007/s12149-021-01625-4. Epub 2021 May 18.

DOI:10.1007/s12149-021-01625-4

PMID:34003458

Abstract

OBJECTIVE

Technetium-99 m sestamibi (Tc-MIBI) scintigraphy can identify non-viable left ventricular (LV) myocardium. However, the optimal cut-off value and the details of decreased Tc-MIBI uptake of the non-viable LV myocardium in patients with dilated cardiomyopathy (DCM) have not been well established. This study aimed to evaluate the decrease in Tc-MIBI uptake in each segment and in the whole LV myocardium, and to determine cut-off values for identifying non-viable LV myocardium in DCM patients.

METHODS

Overall, 53 DCM patients with reduced LV ejection fraction (LVEF ≤ 40%) who underwent Tc-MIBI scintigraphy and any optimization of heart failure treatments were evaluated. LV myocardium was classified as viable or non-viable based on the absolute increase in LVEF of ≥ 10% unit leading to an LVEF of > 40% at follow-up, respectively. The decrease in myocardial Tc-MIBI uptake in each of the 17 segments was evaluated using three indices determined by different thresholds or standard references: segmental %uptake, rest score, and defect extent. Changes in the whole LV myocardium were evaluated by the minimum %uptake, and the summed rest score (SRS) and extent of LV defect were obtained using summed data of 17 segments.

RESULTS

Segmental evaluation indicated a mild decrease in Tc-MIBI uptake in 18 patients with viable LV myocardium, whereas focal severe decrease in uptake was observed in patients with non-viable LV myocardium. In the receiver-operating characteristic curve analysis, the cut-off values of minimum %uptake, SRS, and LV defect extent for predicting non-viable LV were 39% (p < 0.01, area under the curve [AUC]: 0.87), 10 (p < 0.01, AUC: 0.91), and 23% (p < 0.01, AUC: 0.92), respectively.

CONCLUSIONS

In DCM patients, myocardial Tc-MIBI %uptake of < 40% indicated non-viable myocardium. The focal and severe decrease in uptake in approximately more than a quarter of the LV myocardium may indicate non-viable LV.

摘要

目的

锝-99m 甲氧基异丁基异腈（Tc-MIBI）闪烁显像术可识别左心室（LV）无活力心肌。然而，对于扩张型心肌病（DCM）患者，无活力 LV 心肌 Tc-MIBI 摄取减少的最佳临界值和细节尚未明确。本研究旨在评估每个节段和整个 LV 心肌 Tc-MIBI 摄取减少，并确定 DCM 患者中识别无活力 LV 心肌的临界值。

方法

共评估了 53 例 LV 射血分数（LVEF≤40%）降低的 DCM 患者，这些患者均接受了 Tc-MIBI 闪烁显像术，并对心力衰竭进行了任何优化治疗。LV 心肌根据绝对 LVEF 增加≥10%单位，导致随访时 LVEF>40%，分别归类为存活或非存活心肌。使用三种不同阈值或标准参考值确定的指标评估 17 个节段的心肌 Tc-MIBI 摄取减少：节段性摄取百分比、静息评分和缺损程度。通过 17 个节段的总和数据获得整个 LV 心肌的最小摄取百分比、总和静息评分（SRS）和 LV 缺损程度的变化。

结果

在存活 LV 心肌的 18 例患者中，节段评估显示 Tc-MIBI 摄取轻度减少，而在无活力 LV 心肌患者中则观察到局灶性严重摄取减少。在接受者操作特征曲线分析中，预测无活力 LV 的最小摄取百分比、SRS 和 LV 缺损程度的临界值分别为 39%（p<0.01，曲线下面积[AUC]：0.87）、10（p<0.01，AUC：0.91）和 23%（p<0.01，AUC：0.92）。