Zheng Danzha, Liu Yanyun, Zhang Lei, Hu Fan, Tan Xubo, Jiang Dawei, Zhou Weihua, Lan Xiaoli, Qin Chunxia
Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, China.
Front Cardiovasc Med. 2021 Oct 15;8:719565. doi: 10.3389/fcvm.2021.719565. eCollection 2021.
Phase analysis is a technique used to assess left ventricular mechanical dyssynchrony (LVMD) in nuclear myocardial imaging. Previous studies have found an association between LVMD and myocardial ischemia. We aim to assess the potential diagnostic value of LVMD in terms of myocardial viability, and ability to predict major adverse cardiac events (MACE), using Nitrogen-13 ammonia ECG-gated positron emission tomography (gPET). Patients with coronary artery disease (CAD) who underwent Nitrogen-13 ammonia and Fluorine-18 FDG myocardial gPET were enrolled, and their gPET imaging data were retrospectively analyzed. Patients were followed up and major adverse cardiac events (MACE) were recorded. The Kruskal-Wallis test and Mann-Whitney U test were performed to compare LVMD parameters among the groups. Binary logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and multiple stepwise analysis curves were applied to identify the relationship between LVMD parameters and myocardial viability. Kaplan-Meier survival curves and the log-rank test were used to look for differences in the incidence of MACE. In total, 79 patients were enrolled and divided into three groups: Group 1 (patients with only viable myocardium, = 7), Group 2 (patients with more viable myocardium than scar, = 33), and Group 3 (patients with less viable myocardium than scar, = 39). All LVMD parameters were significantly different among groups. The median values of systolic phase standard deviation (PSD), systolic phase histogram bandwidth (PHB), diastolic PSD, and diastolic PHB between Group 1 and Group 3, and Group 2 and Group 3 were significantly different. A diastolic PHB of 204.5° was the best cut-off value to predict the presence of myocardial scar. In multiple stepwise analysis models, diastolic PSD, ischemic extent, and New York Heart Association (NYHA) classification were independent predictive factors of viable myocardium and myocardial scar. The incidence of MACE in patients with diastolic PHB > 204.5° was 25.0%, higher than patients with diastolic PHB <204.5° (11.8%), but the difference was not significant. LVMD generated from Nitrogen-13 ammonia ECG-gated myocardial perfusion imaging had added diagnostic value for myocardial viability assessment in CAD patients. LVMD did not show a definite prognostic value.
相位分析是一种用于评估核素心肌显像中左心室机械性不同步（LVMD）的技术。既往研究发现LVMD与心肌缺血之间存在关联。我们旨在使用氮-13氨心电图门控正电子发射断层扫描（gPET）评估LVMD在心肌存活方面的潜在诊断价值，以及预测主要不良心脏事件（MACE）的能力。纳入接受氮-13氨和氟-18氟代脱氧葡萄糖心肌gPET检查的冠心病（CAD）患者，并对其gPET影像数据进行回顾性分析。对患者进行随访并记录主要不良心脏事件（MACE）。采用Kruskal-Wallis检验和Mann-Whitney U检验比较各组间的LVMD参数。应用二元逻辑回归分析、受试者工作特征（ROC）曲线分析和多元逐步分析曲线来确定LVMD参数与心肌存活之间的关系。采用Kaplan-Meier生存曲线和对数秩检验寻找MACE发生率的差异。总共纳入79例患者并分为三组：第1组（仅有存活心肌的患者，n = 7）、第2组（存活心肌多于瘢痕的患者，n = 33）和第3组（存活心肌少于瘢痕的患者，n = 39）。所有LVMD参数在各组间均有显著差异。第1组与第3组、第2组与第3组之间收缩期标准差（PSD）、收缩期直方图带宽（PHB）、舒张期PSD和舒张期PHB的中位数有显著差异。舒张期PHB为204.5°是预测心肌瘢痕存在的最佳截断值。在多元逐步分析模型中，舒张期PSD、缺血范围和纽约心脏协会（NYHA）分级是存活心肌和心肌瘢痕的独立预测因素。舒张期PHB > 204.5°的患者MACE发生率为25.0%，高于舒张期PHB < 204.5°的患者（11.8%），但差异无统计学意义。由氮-13氨心电图门控心肌灌注显像生成的LVMD对CAD患者心肌存活评估具有额外的诊断价值。LVMD未显示出明确的预后价值。
