^18F-FDG PET心肌代谢显像对左心室室壁瘤患者长期预后的价值  

Long-term survival of patients with left ventricular aneurysm assessed by ^99Tc^m-MIBI SPECT and 18 F-FDG PET

作　　者：张晓丽[1] 刘秀杰[1] 胡盛寿 Thomas H.Schindler 田月琴[1] 高润霖[3] 吴清玉 魏红星[1] 杨秀滨 王浩[4] 何作祥[1] Heinrich R.Schelbert 

机构地区：[1]中国医学科学院、中国协和医科大学阜外心血管病医院核医学科,北京100037 [2]中国医学科学院、中国协和医科大学阜外心血管病医院心外科,北京100037 [3]中国医学科学院、中国协和医科大学阜外心血管病医院心内科,北京100037 [4]中国医学科学院、中国协和医科大学阜外心血管病医院超声科,北京100037 [5]Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA

出　　处：《中华核医学杂志》2008年第6期361-364,共4页Chinese Journal of Nuclear Medicine

摘　　要：目的评估^18F-脱氧葡萄糖（FDG）PET心肌代谢显像对左心室室壁瘤患者长期预后的价值。方法对70例左心室室壁瘤患者[超声心动图示左心室射血分数（LVEF）为（36±8）％]行“Tc”．甲氧基异丁基异腈（MIBI）SPECT心肌灌注显像和“F—FDG PET—心肌代谢显像，对经冠状动脉造影确诊的左心室室壁瘤患者进行随访，计算室壁瘤部位、非室壁瘤部位以及左心室心肌灌注和代谢积分，以及灌注-代谢不匹配分（MMS）。MMS≥2．0为心肌存活。室壁瘤部位心肌不存活者中，药物治疗为组1，手术治疗为组2；室壁瘤部位心肌存活者中，药物治疗为组3，手术治疗为组4。心源性死亡和心脏事件为随访终点。以Kaplan—Meier方法获得生存曲线，并用Log—rank法比较率的差异。结果组1至组4患者例数分别为14，23，10和23例。随访1～105（72±32）个月，16例患者发生心源性死亡。组3的心源性年死亡率为11．6％，高于组4的1．5％（Х^2=12．87，P〈0．0001），也高于组1的4．8％（Х^2=4．13，P〈0．05）和组2的2．2％（Х^2=10．46，P=0．001）。Cox回归多因素分析显示室壁瘤部位的MMS[风险比（HR）1．40，95％可信区间（CI）为1．11～1．75，P=0．003]和血运重建术（HR 0．35，95％CI为0．18～0．69，P=0．002）是预测心源性死亡的独立危险因子。结论“F—FDG PET心肌代谢显像和^99Tc^m-MIBI SPECT心肌灌注显像对于室壁瘤患者的饴疗方案制定及长期预后估测有重要意义。Objective Patients with left ventricular （LV） aneurysms and LV dysfunction have a poor prognosis if treated medically. From the information of PubMed, no viability study in patients with LV aneurysm was available so far. The objective of this study was to evaluate the long-term survival benefit of myocardial viability assessment in patients with LV aneurysm and LV dysfunction with ^Tc^m-methoxyisobutylisonitril （MIBI） SPECT and ^18 F-flourodeoxyglucose （FDG） PET. Methods Seventy consecutive patients with LV aneurysm [LV ejection fraction （EF） was （36 ±8）% ] who underwent ^99Tc^m-MIBI SPECT and ^18F- FDG PET were retrospectively followed up. Only cardiac death [ sudden death, acute myocardial infarction （AMI） and congestive heart failure （CHF） ] during follow-up served as endpoint. Patients were classified in- to four groups by aneurysm viability [ mismatch score （MMS）≥2.0] and by treatment strategy （ medical or surgical therapy）. Cardiac survival curves were generated by the Kaplan-Meier method and compared with the Log-rand test. Results During the period of follow-up [ （72 ± 32） months, range 1 - 105 months ], 16 cardiac death were observed. The annual cardiac mortality rate in patients with viable ane.urysm and treated medically （n = 10） was significantly higher than that in patients with viable aneurysm and treated by surgery （n = 23, 11.6% vs 1.5%,Х^2 = 12.87, P 〈 0.0001 ）, and it was also significantly higher than that in patients with non-viable aneurysm and treated by medical therapy （ n = 14, 4.8%, Х^2 = 4.13, P 〈 0.05 ） or by surgery （ n = 23, 2.2% , Х^2= 10.46, P = 0.001 ）. Multivariate analysis showed that MMS of aneurysm [ hazard ratio （HR） 1.40, 95% confidence interval （CI） 1.11 - 1.75, P = 0. 003 ] and surgical therapy （ HR 0. 35, 95% CI 0. 18 -0. 69, P = 0. 002） were independent predictors of cardiac death. Conclusion Patients with viable aneurysms assessed by ^99Tc^m-MIBI SPECT and ISF-FDG PET were at higher risk for c

关 键 词：心脏室壁瘤 体层摄影术 发射型计算机 脱氧葡萄糖 

分 类 号：R686[医药卫生—骨科学]