小剂量多巴酚丁胺负荷门控血池 SPECT 评估缺血性心肌病左心室收缩储备的可行性研究。
Low-dose dobutamine stress gated blood pool SPECT assessment of left ventricular contractile reserve in ischemic cardiomyopathy: a feasibility study.
机构信息
Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia.
Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Russian Federation, Kievskaya str. 111a, Tomsk, 634012, Russia.
出版信息
Eur J Nucl Med Mol Imaging. 2022 Jun;49(7):2219-2231. doi: 10.1007/s00259-022-05714-y. Epub 2022 Feb 12.
PURPOSE
The purpose of the present study was to evaluate the feasibility of gated blood pool single-photon emission computed tomography (GBPS) with low-dose dobutamine (LDD) stress test, performed on a single-photon emission computed tomography (SPECT) camera equipped with cadmium-zinc-telluride (CZT) solid-state detectors, in assessing of left ventricle (LV) contractile reserve in patients with ischemic cardiomyopathy (ICM).
METHODS
A total of 52 patients (age 59 ± 7.2 years, 47 men and 5 women) with ICM and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15 µg/kg/min). The duration of each GBPS step was 5 min. Stress-induced changes in LV ejection fraction (ΔLVEF), peak ejection rate, LV volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated.
RESULTS
All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. The majority of parameters in ICM patients showed significant changes at a dobutamine dose of 10 µg/kg/min as compared to the rest study. Seventeen percent of ICM patients, but none from the control group, showed a decrease in LVEF during stress, accompanied by a significant increase in entropy. The intra- and inter-observer reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r = 0.5, p = 0.01) between GBPS and TTE, with a mean difference value of - 1.7 (95% confidence interval - 9.8; 6.4; p = 0.06) in ΔLVEF.
CONCLUSION
Low-dose dobutamine stress GBPS performed with high-efficiency CZT-SPECT cameras can be performed for evaluating stress-induced changes in LV contractility and dyssynchrony with lower acquisition time. A dobutamine dose of 10 µg/kg/min can potentially suffice to detect stress-induced changes in patients with ICM during GBPS.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020).
目的
本研究旨在评估低剂量多巴酚丁胺（LDD）负荷试验 gated 血池单光子发射计算机断层扫描（GBPS）在配备碲锌镉（CZT）固态探测器的单光子发射计算机断层扫描（SPECT）相机上评估缺血性心肌病（ICM）患者左心室（LV）收缩储备能力的可行性。
方法
共 52 名 ICM 患者（年龄 59±7.2 岁，47 名男性和 5 名女性）和 10 名无阻塞性冠状动脉病变的对照组患者在静息和 LDD 负荷试验（5、10、15μg/kg/min）时进行了 GBPS 和经胸超声心动图（TTE）检查。每个 GBPS 步骤的持续时间为 5 分钟。评估了 GBPS 获得的 LV 射血分数（ΔLVEF）、峰值射血率、LV 容积和机械不同步（相位直方图标准差、相位直方图带宽和熵）的变化。
结果
两组患者在应激试验中除舒张末期容积外，所有 GBPS 指标均有显著变化。与静息研究相比，ICM 患者的大多数参数在多巴酚丁胺 10μg/kg/min 时显示出显著变化。17%的 ICM 患者在应激时 LVEF 下降，同时熵显著增加，但对照组无一例患者出现这种情况。静息和应激研究的观察者内和观察者间重复性均良好。GBPS 和 TTE 之间存在中度相关性（r=0.5，p=0.01），ΔLVEF 的平均差值为-1.7（95%置信区间-9.8；6.4；p=0.06）。
结论
使用高效 CZT-SPECT 相机进行低剂量多巴酚丁胺应激 GBPS 可用于评估 LV 收缩性和不同步性的应激诱导变化，采集时间更短。10μg/kg/min 的多巴酚丁胺剂量可能足以在 GBPS 中检测 ICM 患者的应激诱导变化。
试验注册
ClinicalTrials.gov 标识符：NCT04508608（2020 年 8 月 7 日）。
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