Saint Luke's Mid America Heart Institute, Kansas City, MO (K.K.P., F.S.P., T.M.B., K.F.K., P.A.P.-O., A.I.M., B.W.S., R.C.T., I.M.S., P.G.J., J.A.S.).
University of Missouri-Kansas City (K.K.P., T.M.B., P.A.P.-O., A.I.M., B.W.S., R.C.T., I.M.S., J.A.S.).
Circ Cardiovasc Imaging. 2022 Feb;15(2):e013592. doi: 10.1161/CIRCIMAGING.121.013592. Epub 2022 Feb 15.
Myocardial perfusion imaging (MPI) identifies abnormalities that occur early in the ischemic cascade leading to angina. Our aim was to study the association between ischemic measures on positron emission tomography MPI and patients' health status; their symptoms, function, and quality of life.
Health status was collected using the Seattle Angina Questionnaire (SAQ-7, 0-100, higher=better) and Rose Dyspnea Score (RDS) on 1515 outpatients with known or suspected coronary artery disease presenting for clinically indicated pharmacological Rb positron emission tomography MPI from July 2018 to July 2019. Adjusted multivariable ordinal regression models were used to assess the association between MPI findings of ischemia and the SAQ physical limitation, angina frequency, quality of life, summary score, and the RDS.
The mean SAQ and RDS scores of the cohort (mean age 71.7 years, 55% male, 37.6% prior myocardial infarction or revascularization) were 73.8±28.6 (physical limitation), 87.4±21.7 (angina frequency), 79.0±26.1 (quality of life), 81.3±19.0 (summary score), and 2±2 (RDS). No perfusion, flow or function abnormalities were significantly associated with SAQ angina frequency scores. Low left ventricular ejection fraction reserve (≤0%), low global and regional myocardial blood flow reserve (<2) were independently associated with worse SAQ Physical Limitation score, SAQ summary score, and RDS (30% to 57% greater odds; all ≤0.01), but reversible perfusion defects were not.
Impaired augmentation of left ventricular ejection fraction and myocardial blood flow with stress is associated with significant angina-associated functional limitation, health status, and dyspnea in patients who underwent positron emission tomography MPI, but not the frequency of their angina. Future studies should evaluate whether therapies that improve stress-induced abnormalities in systolic function and myocardial flow may improve patients' health status.
心肌灌注成像（MPI）可识别导致心绞痛的缺血级联反应早期出现的异常。我们的目的是研究正电子发射断层扫描 MPI 中的缺血性指标与患者健康状况之间的关系，包括他们的症状、功能和生活质量。
我们收集了 1515 例已知或疑似冠心病患者的健康状况数据，这些患者在 2018 年 7 月至 2019 年 7 月期间因临床需要进行放射性核素正电子发射断层扫描 MPI。使用西雅图心绞痛问卷（SAQ-7，0-100，得分越高表示越好）和 Rose 呼吸困难评分（RDS）收集健康状况数据。调整后的多变量有序回归模型用于评估 MPI 缺血发现与 SAQ 躯体受限、心绞痛发作频率、生活质量、综合评分和 RDS 之间的关系。
该队列的平均 SAQ 和 RDS 评分（平均年龄为 71.7 岁，55%为男性，37.6%有心肌梗死或血运重建史）分别为 73.8±28.6（躯体受限）、87.4±21.7（心绞痛发作频率）、79.0±26.1（生活质量）、81.3±19.0（综合评分）和 2±2（RDS）。无灌注、血流或功能异常与 SAQ 心绞痛发作频率评分显著相关。左心室射血分数储备（≤0%）和整体及区域性心肌血流储备（<2）与 SAQ 躯体受限评分、SAQ 综合评分和 RDS 较差独立相关（30%至 57%更高的比值；均≤0.01），但可逆性灌注缺陷无此相关性。
在接受正电子发射断层扫描 MPI 的患者中，左心室射血分数和心肌血流在应激时的增加受损与明显的与心绞痛相关的功能受限、健康状况和呼吸困难有关，但与心绞痛的发作频率无关。未来的研究应评估改善收缩功能和心肌血流应激异常的治疗方法是否可以改善患者的健康状况。
