Department of Medical Sciences, Haematology, Uppsala University, Ing 100, pl 2, Akademiska Hospital, 751 85, Uppsala, Sweden.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
ESC Heart Fail. 2024 Feb;11(1):44-53. doi: 10.1002/ehf2.14545. Epub 2023 Oct 8.
This study aimed to study the prognostic value of myocardial oxygen consumption (MVO ) and myocardial external efficiency (MEE) from C-acetate positron emission tomography (PET) in cardiac amyloidosis (CA) patients.
Forty-eight CA patients, both transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis, and 20 controls were included. All subjects were examined with C-acetate PET and echocardiography. MVO , forward stroke volume (FSV), and left ventricular mass (LVM) were derived from C-acetate PET and used to calculate MEE. CA patients were followed for survival and the prognostic impact of clinical, echocardiographic, and C-acetate PET parameters was analysed. MVO and MEE were reduced in CA compared with controls, but without significant difference between deceased and surviving CA patients. The ratio of C-acetate PET-derived FSV and LVM was also reduced in CA and significantly lowered in deceased patients compared with survivors. In univariate analysis, New York Heart Association class, N-terminal pro-brain natriuretic peptide, and the C-acetate PET parameters FSV/LVM and MEE were the strongest prognostic factors. Of the C-acetate PET parameters, FSV/LVM was the strongest survival predictor with hazard ratio of 0.56 per 0.1 mL/g (95% confidence interval 0.39-0.81, P = 0.002) and independently prognostic in a multivariate model. MEE significantly separated deceased from surviving CA patients with the cut-off of 15.7% (P = 0.032). Survival was significantly shorter with FSV/LVM below 0.27 mL/g (P < 0.001), also when separating AL- and ATTR-CA.
Reduced MEE was associated with shorter survival in CA patients, but FSV/LVM was the strongest survival predictor and the only independently prognostic C-acetate PET parameter in multivariate analysis.
本研究旨在探讨 C-乙酸正电子发射断层扫描（PET）心肌氧耗量（MVO）和心肌外效率（MEE）对心脏淀粉样变性（CA）患者的预后价值。
本研究纳入了 48 例 CA 患者（转甲状腺素蛋白（ATTR）和免疫球蛋白轻链（AL）淀粉样变性）和 20 名对照者。所有受试者均接受 C-乙酸 PET 和超声心动图检查。从 C-乙酸 PET 中得出 MVO、前向射血容积（FSV）和左心室质量（LVM），并用于计算 MEE。对 CA 患者进行生存随访，并分析临床、超声心动图和 C-乙酸 PET 参数的预后影响。与对照组相比，CA 患者的 MVO 和 MEE 降低，但死亡和存活 CA 患者之间无显著差异。与存活患者相比，CA 患者的 C-乙酸 PET 衍生 FSV/LVM 比值也降低，且死亡患者显著降低。在单因素分析中，纽约心脏协会（NYHA）心功能分级、N 末端脑钠肽前体（NT-proBNP）以及 C-乙酸 PET 参数 FSV/LVM 和 MEE 是最强的预后因素。在 C-乙酸 PET 参数中，FSV/LVM 是最强的生存预测因子，每增加 0.1 mL/g，风险比为 0.56（95%置信区间 0.39-0.81，P=0.002），且在多因素模型中具有独立的预后意义。MEE 以 15.7%为界，能显著区分死亡和存活的 CA 患者（P=0.032）。当 FSV/LVM 低于 0.27 mL/g 时，CA 患者的生存率显著降低（P<0.001），且 AL 和 ATTR-CA 也是如此。
在 CA 患者中，MEE 降低与生存率降低相关，但 FSV/LVM 是最强的生存预测因子，且在多因素分析中是唯一具有独立预后意义的 C-乙酸 PET 参数。
