正电子发射断层扫描（PET）存活显像对单光子发射计算机断层扫描（SPECT）心肌瘢痕患者临床转归的影响：再血管化指导作用

Impact of Positron Emission Tomography Viability Imaging: Guided Revascularizations on Clinical Outcomes in Patients With Myocardial Scar on Single-Photon Emission Computed Tomography Scans.

机构信息

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.

School of Medicine, Kyungpook National University, Daegu, Korea.

出版信息

J Korean Med Sci. 2023 Nov 27;38(46):e399. doi: 10.3346/jkms.2023.38.e399.

DOI:10.3346/jkms.2023.38.e399

PMID:38013651

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10681844/

Abstract

BACKGROUND

Positron emission tomography (PET) viability scan is used to determine whether patients with a myocardial scar on single-photon emission computed tomography (SPECT) may need revascularization. However, the clinical utility of revascularization decision-making guided by PET viability imaging has not been proven yet. The purpose of this study was to investigate the impact of PET to determine revascularization on clinical outcomes.

METHODS

Between September 2012 and May 2021, 53 patients (37 males; mean age = 64 ± 11 years) with a myocardial scar on MIBI SPECT who underwent PET viability test were analyzed in this study. The primary outcome was a temporal change in echocardiographic findings. The secondary outcome was all-cause mortality.

RESULTS

Viable myocardium was presented by PET imaging in 29 (54.7%) patients. Revascularization was performed in 26 (49.1%) patients, including 18 (34.0%) with percutaneous coronary intervention (PCI) and 8 (15.1%) with coronary artery bypass grafting. There were significant improvements in echocardiographic findings in the revascularization group and the viable myocardium group. All-cause mortality was significantly lower in the revascularization group than in the medical therapy-alone group (19.2% vs. 44.4%, log-rank = 0.002) irrespective of viable (21.4% vs. 46.7%, log-rank = 0.025) or non-viable myocardium (16.7% vs. 41.7%, log-rank = 0.046). All-cause mortality was significantly lower in the PCI group than in the medical therapy-alone group (11.1% vs. 44.4%, log-rank < 0.001).

CONCLUSION

Revascularization improved left ventricular systolic function and survival of patients with a myocardial scar on SPECT scans, irrespective of myocardial viability on PET scans.

摘要

背景

正电子发射断层扫描（PET）活力扫描用于确定单光子发射计算机断层扫描（SPECT）上有心肌瘢痕的患者是否需要血运重建。然而，PET 活力成像指导的血运重建决策的临床实用性尚未得到证实。本研究旨在探讨 PET 确定血运重建对临床结果的影响。

方法

本研究分析了 2012 年 9 月至 2021 年 5 月期间 53 例（男性 37 例；平均年龄=64±11 岁）MIBI SPECT 上有心肌瘢痕且行 PET 活力检测的患者。主要结局是超声心动图发现的时间变化。次要结局是全因死亡率。

结果

29 例（54.7%）患者 PET 成像显示有存活心肌。26 例（49.1%）患者行血运重建，其中 18 例（34.0%）行经皮冠状动脉介入治疗（PCI），8 例（15.1%）行冠状动脉旁路移植术。血运重建组和存活心肌组的超声心动图发现均有显著改善。无论是否存在存活（21.4% vs. 46.7%，log-rank = 0.025）或非存活（16.7% vs. 41.7%，log-rank = 0.046）心肌，血运重建组的全因死亡率均显著低于单纯药物治疗组（19.2% vs. 44.4%，log-rank = 0.002）。与单纯药物治疗组（11.1% vs. 44.4%，log-rank < 0.001）相比，PCI 组的全因死亡率显著降低。