首页|SPECT心肌血流定量技术对冠状动脉临界狭窄病变患者预后价值的多中心研究

SPECT心肌血流定量技术对冠状动脉临界狭窄病变患者预后价值的多中心研究

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目的 探讨SPECT心肌血流定量技术测得的心肌血流储备(MFR)对冠状动脉(简称冠脉)临界狭窄病变患者的预后价值.方法 前瞻性纳入2019年9月至2021年5月于中国医学科学院阜外医院、阜外华中心血管病医院、泰达国际心血管病医院经冠脉造影确定为临界狭窄病变(狭窄程度为≥50％且≤80％)的患者,均在冠脉造影后3个月内接受一日法静息-药物负荷SPECT心肌灌注显像(MPI)和SPECT心肌血流定量.MPI根据标准5分法获得负荷总分(SSS)和负荷-静息差异总分(SDS)明确是否存在异常.利用ROC曲线获得MFR的预后最佳阈值.研究终点为心血管终点事件.采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归进行预后分析.不同AUC间的比较采用Delong检验.结果 共纳入314例患者,其中男194例、女120例,年龄(59.4±8.6)岁,中位随访时间754(628～914)d.54例患者发生终点事件.ROC曲线显示MFR对终点事件的预测能力明显优于传统MPI(AUCs:0.713和0.512;z=3.76,P＜0.001);MFR预测临界狭窄病变患者发生终点事件的最佳阈值为2.04.Cox多因素分析示MFR[风险比(HR)=0.434(95％C/:0.282～0.669),P＜0.001]为发生终点事件的独立预测因子.Kaplan-Meier生存分析显示MFR≤2.04组的终点事件发生率(25.4％,43/169)明显高于 MFR＞2.04 组(7.6％,11/145;x2=21.27,P＜0.001).结论 SPECT 心肌血流定量技术测定的MFR对冠脉临界狭窄病变患者发生心血管终点事件有独立的预测价值.
A multicenter study on the prognostic value of SPECT myocardial blood flow quantitative technique in patients with intermediate stenoses of coronary arteries
Objective To investigate the prognostic value of myocardial flow reserve(MFR)meas-ured by SPECT myocardial blood flow(MBF)quantitative technique in patients with intermediate stenoses of coronary arteries.Methods From September 2019 to May 2021,patients with intermediate stenoses(50％to 80％)identified by invasive coronary angiography in Fuwai Hospital,Chinese Academy of Medical Sciences,Fuwai Center China Cardiovascular Hospital,and TEDA International Cardiovascular Hospital were prospectively included.All patients underwent a one-day rest/stress SPECT myocardial perfusion imaging(MPI)and SPECT MBF quantification.The radioactivity distribution of each segment of the MPI bullseye polar maps were obtained according to the standard 5-point method to obtain the summed stress score(SSS)and the summed difference score(SDS)to determine the existence of abnormality.ROC curve analysis was used to obtain the optimal prognostic cut-off value for MFR.The primary endpoint was defined as cardiovascular endpoint events.Survival and prognostic analyses were conducted by Kaplan-Meier method and Cox proportion-al hazard models.The difference of AUCs was analyzed by Delong test.Results A total of 314 patients(194 males,120 females;age(59.4±8.6)years)were enrolled.Over a median follow-up duration of 754(range:628-914)d,54 patients had endpoint events.ROC curve showed that the prediction ability of MFR was significantly better than that of conventional MPI(AUCs:0.713 and 0.512;z=3.76,P＜0.001).The optimal prognostic cut-off value for MFR to predict endpoint events in patients with intermediate stenoses was 2.04.Cox multivariate analysis showed that MFR(hazard ratio(HR)=0.434,95％CI:0.282-0.669,P＜0.001)was an independent predictor of endpoint events in patients with intermediate stenoses.Kaplan-Meier survival analysis showed that the prevalence of endpoint events in patients with MFR ≤ 2.04 was significantly higher than that in patients with MFR＞2.04(25.4％(43/169)vs 7.6％(11/145);x2=21.27,P＜0.001).Conclusion The MFR measured by SPECT MBF quantitative technique has an independent predictive val-ue for cardiovascular endpoint events in patients with intermediate stenoses.

Coronary artery diseaseFractional flow reserve,myocardialMyocardial perfusion imagingTomography,emission-computed,single-photonTechnetium Tc 99m sestamibiPrognosis

孙若西、庞泽堃、马荣政、汪蕾、张杰、李剑明、方纬

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北京协和医学院、中国医学科学院阜外医院核医学科,北京 100037

泰达国际心血管病医院核医学科,天津 300457

阜外华中心血管病医院核医学科,郑州 450003

冠状动脉疾病 血流储备分数,心肌 心肌灌注显像 体层摄影术,发射型计算机,单光子 99m锝甲氧基异丁基异腈 预后

北京市科技计划

Z191100006619017

2024

10.3760/cma.j.cn321828-20230210-00033

中华核医学与分子影像杂志
中华医学会

中华核医学与分子影像杂志

CSTPCD北大核心
影响因子：1.107
ISSN：2095-2848
年,卷(期)：2024.44(3)
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