Filidei Elena, Caselli Chiara, Menichetti Luca, Poli Michela, Petroni Debora, Guiducci Letizia, Sorace Oreste, Pisani Patrizia, Pardini Silvia, Bonora Danilo, Giorgetti Assuero, Gimelli Alessia, Neglia Danilo
Imaging Department-Nuclear Medicine Unit, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
CNR Institute of Clinical Physiology (IFC), Pisa, Italy.
Eur Heart J Imaging Methods Pract. 2024 Jul 13;2(3):qyae070. doi: 10.1093/ehjimp/qyae070. eCollection 2024 Jul.
Cardiometabolic risk factors, including high fasting plasma glucose (hFPG), are emerging prognostic determinants in patients with coronary artery disease (CAD) or heart failure (HF). Coronary microvascular dysfunction might be a comprehensive risk predictor in these patients. The purpose of this study was to assess whether hFPG and global myocardial blood flow (MBF) reserve measured by positron emission tomography (PET), expressing global coronary function, predict long-term prognosis beyond other risk factors and presence of obstructive CAD or left ventricular (LV) dysfunction associated with HF. We retrospectively collected long-term follow-up data in 103 patients (mean age 61 ± 10 years, 74 males) with stable chest pain or dyspnoea who underwent cardiac PET/computerized tomography and coronary angiography. Disease phenotypes included obstructive CAD (35%), LV dysfunction without obstructive CAD (43%), or none (22%). At multivariable logistic regression analysis, MBF reserve lower than the median value (OR 1.8, 95% CI 1.5-2.2) was significantly associated with male gender (OR 3.45, 95% CI 1.21-9.83) and hFPG (OR 3.87, 95% CI 1.17-12.84) among all risk factors. In a median follow-up of 10.9 years (interquartile range 7.8-13.9), 39 patients (37.8%) died (13.6% cardiac death). At multivariable Cox analyses including all risk factors and disease phenotypes, age (HR 1.07, 95% CI 1.02-1.12), hFPG (HR 2.18, 95% CI 1.02-4.63), and depressed MBF reserve (HR 4.47, 95% CI 1.96-10.18) were independent predictors of death (global 37.41, = 0.0004). These results suggest a strong long-term prognostic role of hFPG and depressed MBF reserve in a high-risk population of patients with a high prevalence of obstructive CAD or HF.
包括空腹血糖升高（hFPG）在内的心血管代谢危险因素，正成为冠状动脉疾病（CAD）或心力衰竭（HF）患者新的预后决定因素。冠状动脉微血管功能障碍可能是这些患者的综合风险预测指标。本研究的目的是评估hFPG和通过正电子发射断层扫描（PET）测量的整体心肌血流（MBF）储备（反映整体冠状动脉功能）是否能独立于其他危险因素以及与HF相关的阻塞性CAD或左心室（LV）功能障碍来预测长期预后。我们回顾性收集了103例（平均年龄61±10岁，男性74例）有稳定胸痛或呼吸困难症状的患者的长期随访数据，这些患者均接受了心脏PET/计算机断层扫描和冠状动脉造影。疾病表型包括阻塞性CAD（35%）、无阻塞性CAD的LV功能障碍（43%）或两者皆无（22%）。在多变量逻辑回归分析中，MBF储备低于中位数（比值比1.8，95%置信区间1.5 - 2.2）与所有危险因素中的男性性别（比值比3.45，95%置信区间1.21 - 9.83）和hFPG（比值比3.87，95%置信区间1.17 - 12.84）显著相关。在中位随访10.9年（四分位间距7.8 - 13.9年）期间，39例患者（37.8%）死亡（13.6%为心源性死亡）。在包括所有危险因素和疾病表型的多变量Cox分析中，年龄（风险比1.07，95%置信区间1.02 - 1.12）、hFPG（风险比2.18，95%置信区间1.02 - 4.63）和MBF储备降低（风险比4.47，95%置信区间1.96 - 10.18）是死亡的独立预测因素（整体χ² = 37.41，P = 0.0004）。这些结果表明，在阻塞性CAD或HF患病率较高的高危患者群体中，hFPG和MBF储备降低具有很强的长期预后作用。
