Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
Clin Physiol Funct Imaging. 2024 Nov;44(6):454-462. doi: 10.1111/cpf.12899. Epub 2024 Aug 18.
Myocardial perfusion SPECT (MPS) and exercise electrocardiography (Ex-ECG) results are of prognostic importance for short-term follow up duration. However, the value of MPS or Ex-ECG findings for long-term risk assessment is less evident as underlying risk factors for ischemic heart disease (IHD) gain in importance.
To assess the short- and long-term prognostic value of MPS and Ex-ECG in relation to known risk factors.
An observational study of 908 patients (age 63 years, 49% male, 45% prior IHD) referred for MPS and Ex-ECG. Follow-up was divided into two periods (short-term: <5 years and long-term: >5 years). Cardiac events were defined as a composite of acute myocardial infarction, unstable angina, unplanned revascularization and cardiovascular death.
The composite endpoint occurred in 95 patients (short-term follow up) and in 94 patients (long-term follow up). In multivariable models stress testing had a strong predictive value for short-term follow up (HR for MPS = 2.9, CI = 1.9-4.5, p < 0.001 and HR for Ex-ECG = 2.1, CI 1.3-3.3, p = 0.002), but no predictive value for long-term follow up (HR for MPS = 0.9, CI = 0.5-1.5, p = 0.70 and HR for Ex-ECG = 1.0, CI = 0.6-1.6, p = 0.92). Male sex and prior IHD were significant predictors regardless of follow up duration. Age, diabetes and decreased exercise capacity were risk factors for long-term follow up.
The prognostic value of MPS and Ex-ECG results are strong for short-term follow up but diminish over time and do not contribute significantly in multivariable models after 5 years. Long-term prognosis is primarily governed by underlying risk factors and exercise capacity.
心肌灌注 SPECT（MPS）和运动心电图（Ex-ECG）的结果对短期随访时间具有预后意义。然而，MPS 或 Ex-ECG 检查结果对长期风险评估的价值不太明显，因为缺血性心脏病（IHD）的潜在危险因素变得更加重要。
评估 MPS 和 Ex-ECG 与已知危险因素的短期和长期预后价值。
对 908 例（年龄 63 岁，49%为男性，45%有 IHD 病史）接受 MPS 和 Ex-ECG 检查的患者进行观察性研究。随访分为两个时期（短期：<5 年和长期：>5 年）。心脏事件定义为急性心肌梗死、不稳定型心绞痛、非计划性血运重建和心血管死亡的复合终点。
95 例患者（短期随访）和 94 例患者（长期随访）发生了复合终点事件。多变量模型显示，应激试验对短期随访具有很强的预测价值（MPS 的 HR=2.9，CI=1.9-4.5，p<0.001，Ex-ECG 的 HR=2.1，CI=1.3-3.3，p=0.002），但对长期随访无预测价值（MPS 的 HR=0.9，CI=0.5-1.5，p=0.70，Ex-ECG 的 HR=1.0，CI=0.6-1.6，p=0.92）。男性和 IHD 病史是无论随访时间长短都是重要的预测因素。年龄、糖尿病和运动能力下降是长期随访的危险因素。
MPS 和 Ex-ECG 结果对短期随访具有很强的预后价值，但随着时间的推移会逐渐减弱，并且在 5 年后的多变量模型中对预测结果没有显著贡献。长期预后主要由潜在的危险因素和运动能力决定。
