Ladenheim M L, Pollock B H, Rozanski A, Berman D S, Staniloff H M, Forrester J S, Diamond G A
J Am Coll Cardiol. 1986 Mar;7(3):464-71. doi: 10.1016/s0735-1097(86)80454-5.
The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass surgery more than 60 days after testing). Stepwise logistic regression identified only three independent predictors: the number of myocardial regions with reversible hypoperfusion (an index of the extent of hypoperfusion), the maximal magnitude of hypoperfusion (an index of the severity of hypoperfusion) and the achieved heart rate (an index of exercise performance). Both extent and severity were exponentially correlated with event rate (r greater than 0.97 and p less than 0.01 for each), whereas achieved heart rate was linearly correlated with event rate (r = 0.79 and p less than 0.05). On the basis of these data, a prognostic model was defined that employs extent and severity as stress-dependent orthogonal variables. Using this model, the predicted coronary event rate ranged over two orders of magnitude--from a low of 0.4% in patients able to exercise adequately without developing severe and extensive hypoperfusion at a low heart rate (less than 85% of their maximal predicted heart rate). Extent and severity of myocardial hypoperfusion, therefore, are important independent variables of prognosis in patients with suspected coronary artery disease.
在1689例有冠状动脉疾病症状但既往无心肌梗死或冠状动脉搭桥手术史的患者中，评估了运动诱发的心肌灌注不足在铊闪烁扫描上预测冠状动脉事件的能力。共有74例患者在检测后一年内发生冠状动脉事件（12例心源性死亡，20例非致死性梗死，42例在检测后60天以上转诊行搭桥手术）。逐步逻辑回归仅确定了三个独立预测因素：可逆性灌注不足的心肌区域数量（灌注不足范围的指标）、灌注不足的最大程度（灌注不足严重程度的指标）和达到的心率（运动表现的指标）。范围和严重程度均与事件发生率呈指数相关（两者r均大于0.97，p均小于0.01），而达到的心率与事件发生率呈线性相关（r = 0.79，p小于0.05）。基于这些数据，定义了一个预后模型，该模型将范围和严重程度用作应激依赖的正交变量。使用该模型，预测的冠状动脉事件发生率范围超过两个数量级——从能够在低心率（低于其最大预测心率的85%）下充分运动且未发生严重和广泛灌注不足的患者中的低至0.4%。因此，心肌灌注不足的范围和严重程度是疑似冠状动脉疾病患者预后的重要独立变量。
