在一项大型国际多中心研究中，使用高效固态探测器的心肌灌注单光子发射计算机断层扫描在男性和女性中的预后价值存在差异。
Differences in Prognostic Value of Myocardial Perfusion Single-Photon Emission Computed Tomography Using High-Efficiency Solid-State Detector Between Men and Women in a Large International Multicenter Study.
机构信息
Department of Medicine (Division of Artificial Intelligence), Imaging, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles (B.K.T., Y.O., L.-H.H., H.G., E.E., J.X.L., D.D., D.S.B., P.J.S.).
Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, Israel (T.S.).
出版信息
Circ Cardiovasc Imaging. 2022 Jun;15(6):e012741. doi: 10.1161/CIRCIMAGING.121.012741. Epub 2022 Jun 21.
BACKGROUND
Semiquantitative assessment of stress myocardial perfusion defect has been shown to have greater prognostic value for prediction of major adverse cardiac events (MACE) in women compared with men in single-center studies with conventional single-photon emission computed tomography (SPECT) cameras. We evaluated sex-specific difference in the prognostic value of automated quantification of ischemic total perfusion defect (ITPD) and the interaction between sex and ITPD using high-efficiency SPECT cameras with solid-state detectors in an international multicenter imaging registry (REFINE SPECT [Registry of Fast Myocardial Perfusion Imaging With Next-Generation SPECT]).
METHODS
Rest and exercise or pharmacological stress SPECT myocardial perfusion imaging were performed in 17 833 patients from 5 centers. MACE was defined as the first occurrence of death or myocardial infarction. Total perfusion defect (TPD) at rest, stress, and ejection fraction were quantified automatically by software. ITPD was given by stressTPD-restTPD. Cox proportional hazards model was used to evaluate the association between ITPD versus MACE-free survival and expressed as a hazard ratio.
RESULTS
In 10614 men and 7219 women, with a median follow-up of 4.75 years (interquartile range, 3.7-6.1), there were 1709 MACE. In a multivariable Cox model, after adjusting for revascularization and other confounding variables, ITPD was associated with MACE (hazard ratio, 1.08 [95% CI, 1.05-1.1]; <0.001). There was an interaction between ITPD and sex (<0.001); predicted survival for ITPD<5% was worse among men compared to women, whereas survival among women was worse than men for ITPD≥5%, <0.001.
CONCLUSIONS
In the international, multicenter REFINE SPECT registry, moderate and severe ischemia as quantified by ITPD from high-efficiency SPECT is associated with a worse prognosis in women compared with men.
背景
在单中心研究中，与传统单光子发射计算机断层扫描（SPECT）相机相比，半定量评估应激性心肌灌注缺损对女性主要不良心脏事件（MACE）的预测具有更大的预后价值。我们使用高效 SPECT 相机和固体探测器在国际多中心成像注册研究（REFINE SPECT [下一代 SPECT 快速心肌灌注成像注册研究]）中评估了自动化定量缺血性总灌注缺损（ITPD）的预后价值以及性别与 ITPD 之间的交互作用在女性中的性别特异性差异。
方法
在来自 5 个中心的 17833 例患者中进行了静息和运动或药物负荷 SPECT 心肌灌注成像。MACE 定义为首次死亡或心肌梗死。通过软件自动定量静息时、应激时和射血分数的总灌注缺损（TPD）。ITPD 由应激 TPD-静息 TPD 给出。使用 Cox 比例风险模型评估 ITPD 与 MACE 无事件生存之间的关系，并表示为风险比。
结果
在 10614 名男性和 7219 名女性中，中位随访时间为 4.75 年（四分位距，3.7-6.1），有 1709 例 MACE。在多变量 Cox 模型中，在校正了血运重建和其他混杂变量后，ITPD 与 MACE 相关（风险比，1.08[95%CI，1.05-1.1]；<0.001）。ITPD 与性别之间存在交互作用（<0.001）；与女性相比，ITPD<5%的预测生存率较差，而 ITPD≥5%时女性的生存率较男性差，<0.001。
结论
在国际多中心 REFINE SPECT 注册研究中，与男性相比，高效 SPECT 定量的中重度缺血与女性预后较差相关。
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