门控心肌灌注成像相位分析对冠心病患者主要心脏不良事件的预测价值

中华核医学与分子影像杂志 Pub Date : 2020-03-25 DOI:10.3760/CMA.J.CN321828-20190816-00171

S. Luo, Z. Yao, Congxia Chen, Xu Li, Yue Guo, Zhiguo Yu, Yuyi Zhang

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Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. \n \n \nResults \nA total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. 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引用次数: 0

摘要

目的评价门控心肌灌注成像（GMPI）相位分析在预测冠状动脉粥样硬化性心脏病患者主要心脏不良事件（MACE）中的价值。方法选择2012年9月至2014年1月在北京医院核内科接受为期两天休息应激性GMPI的患者作为观察对象，进行回顾性分析。记录一般临床信息、GMPI图像和相关参数，包括相位标准差（PSD）、相位直方图带宽（PBW）、熵、左心室射血分数（LVEF）、总应力评分（SSS）、峰值射血率（PER）和峰值充盈率（PFR）。对患者进行随访，直到MACE发作（心脏死亡、非致命性心肌梗死和GMPI后60天内的晚期血运重建）。采用χ2检验、独立样本t检验或Wilcoxon秩和检验对不同组间数据进行比较。采用Cox比例风险回归模型得到MACE的独立危险因素。Kaplan-Meier生存曲线分析用于分析无MACE的累积生存率。结果共有505名患者（235名男性，270名女性，中位年龄：73岁）获得成功随访，中位随访期为55.6（52.0，60.5）个月。MACE共有54例（10.7%）：6例心源性死亡，27例非致命性心肌梗死，21例晚期血运重建。MACE患者的高血压和高脂血症发生率显著高于非MACE患者（χ2值：4.126，6.021，均为P 80°）、异常熵（>58J·mol-1·K-1）和SSS≥12是MACE的独立危险因素（比值比（OR）值：2.795（95%CI:1.259-6.201）、3.213（95%CI+1.468-7.029）、3.640（95%CI=1.99-6.628），均为P 26.7°），异常PBW组和异常熵组分别为51.2%、63.2%和46.7%，显著低于正常PSD组（92.3%；χ2=77.768，P<0.05），正常PBW组（94.2%；χ2=77.741，P<0.05）和正常熵组（92.8%；χ2=117.437，P<0.05）后果结论PBW和GMPI相位分析得到的熵是预测冠心病MACE的独立危险因素。GMPI相位分析可用于冠状动脉疾病风险分层。关键词：冠状动脉疾病；预后；心肌灌注成像；层析成像，发射计算机，单光子；层析成像，X射线计算机；99m倍他米锝

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Predictive value of phase analysis of gated myocardial perfusion imaging for major adverse cardiac events in patients with coronary artery disease

Objective To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease. Methods Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE (χ2 values: 4.126, 6.021, both P 80°), abnormal entropy(>58 J·mol-1·K-1) and SSS≥12 were independent risk factors for MACE (odds ratio(OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P 26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification. Key words: Coronary artery disease; Prognosis; Myocardial perfusion imaging; Tomography, emission-computed, single-photon; Tomography, X-ray computed; Technetium Tc 99m sestamibi

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来源期刊

中华核医学与分子影像杂志核医学，分子影像

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期刊介绍： Chinese Journal of Nuclear Medicine and Molecular Imaging (CJNMMI) was established in 1981, with the name of Chinese Journal of Nuclear Medicine, and renamed in 2012. As the specialized periodical in the domain of nuclear medicine in China, the aim of Chinese Journal of Nuclear Medicine and Molecular Imaging is to develop nuclear medicine sciences, push forward nuclear medicine education and basic construction, foster qualified personnel training and academic exchanges, and popularize related knowledge and raising public awareness. Topics of interest for Chinese Journal of Nuclear Medicine and Molecular Imaging include: -Research and commentary on nuclear medicine and molecular imaging with significant implications for disease diagnosis and treatment -Investigative studies of heart, brain imaging and tumor positioning -Perspectives and reviews on research topics that discuss the implications of findings from the basic science and clinical practice of nuclear medicine and molecular imaging - Nuclear medicine education and personnel training - Topics of interest for nuclear medicine and molecular imaging include subject coverage diseases such as cardiovascular diseases, cancer, Alzheimer’s disease, and Parkinson’s disease, and also radionuclide therapy, radiomics, molecular probes and related translational research.