经皮冠状动脉介入治疗后有症状患者心肌灌注受损的临床及影像学预测因素：动态CT心肌灌注成像的见解
Clinical and imaging predictors of impaired myocardial perfusion in symptomatic patients after percutaneous coronary intervention: insights from dynamic CT myocardial perfusion imaging.
作者信息
Ma Haiyan, Dai Xu, Yang Xiaojun, Zhao Xihui, Wang Rongpin, Zhang Jiayin
机构信息
Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, China.
出版信息
Quant Imaging Med Surg. 2021 Jul;11(7):3327-3337. doi: 10.21037/qims-20-977.
BACKGROUND
We aimed to investigate the relationship between baseline clinical characteristics and postprocedural myocardial perfusion as determined by dynamic computed tomography myocardial perfusion imaging (CT-MPI).
METHODS
We retrospectively included consecutive symptomatic post percutaneous coronary intervention (PCI) patients, who underwent dynamic CT-MPI + coronary CT angiography (CCTA) and who were revealed to have patent stents on previously revascularized lesions. Myocardial blood flow (MBF) was measured for stented territories and reference territories. Various baseline clinical and angiographic parameters were tested for the association with reduced MBF of stented territories.
RESULTS
A total of 81 patients with 96 stented vessels were included in the analysis. The mean effective doses of radiation for the whole integrated CT protocol (calcium score + dynamic CT-MPI + CCTA) was 4.89±1.14 (2.58-6.93) mSv. Overall, 49 stented vessels had reduced MBF (75.3±17.2 mL/100 mL/min) within related territories, whereas 47 stented vessels had normal MBF (138.6±20.5 mL/100 mL/min). Peak levels of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and glucose were significantly higher, while preprocedural thrombolysis in myocardial infarction (TIMI) flow grade was lower in participants with reduced MBF of stented territories. Acute myocardial infarction (AMI) also predominantly presented in participants with decreased MBF after revascularization. According to multivariate analysis, peak hs-cTnI level was the strongest predictor [adjusted hazard ratio (HR): 4.548, P=0.003] for decreased myocardial perfusion, followed by TIMI flow grade, AMI, stenotic extent, and NT-pro-BNP.
CONCLUSIONS
The baseline hs-cTnI peak level was the strongest predictor for decreased myocardial perfusion after revascularization, followed by AMI, stenotic extent, and NT-pro-BNP.
背景
我们旨在研究基线临床特征与动态计算机断层扫描心肌灌注成像（CT-MPI）所确定的术后心肌灌注之间的关系。
方法
我们回顾性纳入了连续的有症状的经皮冠状动脉介入治疗（PCI）术后患者，这些患者接受了动态CT-MPI + 冠状动脉CT血管造影（CCTA）检查，且先前血运重建的病变部位支架通畅。测量支架置入区域和对照区域的心肌血流量（MBF）。测试各种基线临床和血管造影参数与支架置入区域MBF降低之间的相关性。
结果
分析共纳入81例患者的96条支架血管。整个综合CT方案（钙化积分 + 动态CT-MPI + CCTA）的平均有效辐射剂量为4.89±1.14（2.58 - 6.93）mSv。总体而言，49条支架血管相关区域的MBF降低（75.3±17.2 mL/100 mL/min），而47条支架血管的MBF正常（138.6±20.5 mL/100 mL/min）。支架置入区域MBF降低的参与者中，高敏心肌肌钙蛋白I（hs-cTnI）、N末端B型脑钠肽原（NT-pro-BNP）、高敏C反应蛋白（hs-CRP）和血糖的峰值水平显著更高，而术前心肌梗死溶栓（TIMI）血流分级更低。急性心肌梗死（AMI）也主要出现在血运重建后MBF降低的参与者中。根据多因素分析，hs-cTnI峰值水平是心肌灌注降低的最强预测因素[调整后风险比（HR）：4.548，P = 0.003]，其次是TIMI血流分级、AMI、狭窄程度和NT-pro-BNP。
结论
基线hs-cTnI峰值水平是血运重建后心肌灌注降低的最强预测因素，其次是AMI、狭窄程度和NT-pro-BNP。
Zotero 插件