^(18)F-FDGPET心肌代谢显像对冠心病左心功能受损患者的预后价值  

Prognostic value of ^(18)F-FDG positron emission tomography in patients with coronary artery disease and leftventricular dysfunction

作　　者：张晓丽[1] 刘秀杰[1] 史蓉芳[1] 吴清玉[2] 高润霖[3] 刘蕴忠[1] 田月琴[1] 胡盛寿[2] 王文明[1] 方纬[1] 褚克维[1] 魏红星[1] 郭风[1] 周宝贵[1] 吴清文[1] 郭少先[2] 

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

出　　处：《中华核医学杂志》2000年第4期145-147,共3页Chinese Journal of Nuclear Medicine

摘　　要：目的　评价1 8F 脱氧葡萄糖 (FDG)OET心肌代谢显像对冠心病左心功能受损患者的预后价值 ,及其在选择治疗方案中的作用。方法　 10 7例 [(男 98例 ,女 9例 ,年龄 (5 7± 9)岁 ],行1 8F FDGPET心肌代谢显像与90 Tcm 甲氧基异丁基异腈 (MIBI)心肌灌注显像 ,确诊为冠心病伴有左心功能受损 [LVEF(38± 9) % ]的患者随诊 (2 4± 5 )个月。左心室各节段分为灌注 代谢不匹配 (MM)和灌注 代谢匹配 (M) 2种。 48例接受药物治疗 ,5 9例行血运重建术。 46例患者在血运重建术后 3个月、2 3例患者在术后 6个月复查超声心动图。患者在随诊期间如发生心源性死亡、急性心肌梗死、不稳定性心绞痛或晚期血运重建术 (>3个月 )则认为有心脏事件发生。结果　①MM节段≥ 2个为心肌存活组 (MM组 ,6 4例 ) ;MM <2个为心肌梗死组 (M组 ,43例 )。根据治疗方案将MM和M组又分为接受血运重建术的MM1组 (35例 )和M1组 (2 4例 ) ,接受药物治疗的MM2组 (2 9例 )和M2组 (19例 )。 4组间性别、年龄、危险因素均无明显差别。②MM1组的LVEF术前为 (38± 8) % ,术后 3和 6个月分别为(48± 10 ) %和 (5 2± 10 ) % (P <0 0 1) ;左心室舒张末期内径 (LVEDD)术前为 (6 2± 8)mm ,术后 3和 6个月分别缩小为 (5 3± 7)mm和 (5 3± 8)mm(P <0 0 1)Objective To evaluate the prognostic value of 18 F FDG positron emission tomography(PET)in patients(pts)with coronary artery disease(CAD)and left ventricular dysfunction and to clarify whether revas cularization(RVS) will decrease the cardiac events in pts with myocardial perfusion metabolism mismatch(MM).Methods 107 consecutive pts(mean age 57±9 yr.)with CADand left ventricular dysfunction[left ventricular ejection fraction(LVEF)=(38±9%)]who underwent 18 F FDG PET imaging and 99 Tc m MIBI SPECT imaging were followed up for(24±5)months.Myocardial segments were classified as myocardial perfusion metabolism mismatch(MM) and match (M).LVEF and left ventricular end diastolic diameter (LVEDD)were measured with echocardiography (Echo).Results Fifty nine pts underwent RVSand 48 pts underwent medical therapy.Three months(POS1) and 6 months (POS2) after RVS,Echo was performed on forty six pts and 23 pts,respectively.Cardiac death,myocardial infarction,unstable angina pectoris and late RVS(>3 mon) were considered as cardi ac events.Among 64 patients with 2 or more MM segments, 35 pts received RVS(MM1) and 29 pts received medical therapy (MM2). Among 43 pts with less than 2 MM segments, 24 pst underwent RVS (M1) and 19 ptsunderwent medical therapy (M2). After RVS,LVEF in MM1 was increased from (38±8)% to (48±10)%( P <0.01) in POS1 and to (52±10)%( P <0.01) in POS2.LVEDD in MM1 was decreased from(62±8) mm to(53±7) mm ( P <0.01) in POS1 and to(53±8) mm ( P <0.01) in POS2.However,LVEF and LVEDD was unchanged in M1 after RVS( P >0.05).The cardiac event rate of 51.7%(15/29) in MM2 was significantlyhigher than that of 2.9%(1/35) in MM1( x 2=20/14, P <0.01),and higher than that of OF 16/7%(4/24) in M1( x 2=7.02, P <0.01) and that of 21.1% in M2( x 2=4.52, P <0.01).Conclusions The results suggest that the presence of MM in pts with CAD and left ventricular dysfunction is associated with poor prognosis on medical therapy,and these pts may need aggressive RVS to prevent

关 键 词：冠心病 ^18F-FDG PET 心肌代谢显像 左心功能 

分 类 号：R541.4[医药卫生—心血管疾病] R817.42[医药卫生—内科学]