Shipulin Vladimir V, Andreev Sergey, Kopeva Kristina, Shipulin Vladimir M, Zavadovsky Konstantin
Nuclear Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia.
Surgical Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia.
J Clin Med. 2023 Aug 16;12(16):5328. doi: 10.3390/jcm12165328.
(1) Objective: The objective of this study was to assess the prognostic value of stress-gated blood pool SPECT (GBPS) estimates in patients with ischemic cardiomyopathy (ICM) in the early postoperative period. (2) Methods: A total of 57 patients (age 59.7 ± 6.6, 47 men) with ICM and LV ejection fraction (30 [27.5; 35]%) were enrolled in the study. Before surgical treatment, all patients underwent GBPS (rest-stress, dobutamine doses of 5/10/15 µg/kg/min). Stress-induced changes in left ventricular (LV) ejection fraction, peak ejection rate, volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase entropy (PE), and phase histogram bandwidth) were estimated. Two-dimensional transthoracic echocardiography was performed baseline. Serum levels of NT-proBNP were analyzed with enzyme-linked immunoassay. (3) Results: After surgical treatment, patients were divided into two groups, one, with death, the need for an intra-aortic balloon pump (IABP) or/and inotropic support with a stay in the intensive care unit for more than two days and two, without complications in the early postoperative period (EPOP). Complicated EPOP (CEPOP) was observed in 17 (30%) patients (death-2, IABP-4, extra inotropic support in intensive care unit-11), and 40 patients had no complications (NCEPOP). GBPS showed differences in LV EDV (mL) (321 [268; 358] vs. 268 [242; 313], = 0.02), LV ESV (mL) (242 [201; 282] vs. 196 [170; 230], = 0.005), and stress-induced changes in PE (1 (-2; 3) vs. -2 (-4; 0), = 0.02). Aortic cross-clamp time and stress-induced changes in PE between rest and dobutamine dose of 10 µg/kg/min were the only independent predictors of CEPOP. An increase in LV entropy ≥ 1 on the dobutamine dose of 10µg/kg/min in comparison to rest investigation showed AUC = 0.853 (sensitivity = 62%, specificity = 90%, PPV = 71%; NPV = 85%; < 0.0001). Conclusion: Stress-induced changes in PE obtained during low-dose dobutamine GBPS are associated with a complicated course of the early postoperative period after surgical treatment for ICM.
(1) 目的：本研究的目的是评估应激门控血池单光子发射计算机断层扫描（GBPS）评估结果对缺血性心肌病（ICM）患者术后早期的预后价值。(2) 方法：共纳入57例ICM患者（年龄59.7±6.6岁，47例男性），左心室射血分数为30[27.5；35]%。在手术治疗前，所有患者均接受GBPS检查（静息-应激，多巴酚丁胺剂量为5/10/15μg/kg/min）。评估应激诱导的左心室（LV）射血分数、峰值射血率、容积和机械不同步性（相位直方图标准差、相位熵（PE）和相位直方图带宽）的变化。在基线时进行二维经胸超声心动图检查。采用酶联免疫分析法分析血清NT-proBNP水平。(3) 结果：手术治疗后，患者被分为两组，一组为死亡、需要主动脉内球囊泵（IABP）或/和使用血管活性药物支持且在重症监护病房停留超过两天的患者，另一组为术后早期（EPOP）无并发症的患者。17例（30%）患者出现复杂的EPOP（CEPOP）（死亡2例，IABP 4例，重症监护病房额外使用血管活性药物支持11例），40例患者无并发症（NCEPOP）。GBPS显示左心室舒张末期容积（mL）存在差异（321[268；358] vs. 268[242；313]，P = 0.02），左心室收缩末期容积（mL）存在差异（242[201；282] vs. 196[170；230]，P = 0.005），以及应激诱导的PE变化存在差异（1（-2；3） vs. -2（-4；0）），P = 0.02）。主动脉阻断时间和静息与多巴酚丁胺剂量为10μg/kg/min时应激诱导的PE变化是CEPOP的唯一独立预测因素。与静息检查相比，多巴酚丁胺剂量为10μg/kg/min时左心室熵增加≥1显示曲线下面积（AUC）= 0.853（敏感性 = 62%，特异性 = 90%，阳性预测值 = 71%；阴性预测值 = 85%；P < 0.0001）。结论：在低剂量多巴酚丁胺GBPS检查期间获得的应激诱导的PE变化与ICM手术治疗后术后早期的复杂病程相关。
