比较门控心肌代谢显像等几种不同影像技术测定心室重构参数对室壁瘤患者估测预后的价值  

Prognostic Value of Left Ventricular Remodeling Parameter Comparison of Gated Photon Emission Tomography With Several Imaging Technologies in Patients With Left Ventricular Aneurysm

作　　者：魏红星[1] 田丛娜[1] 王伟学[1] 杨易剑 科雨桐 陆敏杰[2] 张红菊[3] 田月琴[1] 赵世华[2] 张健[4] 张晓丽[1] 刘秀杰[1] 

机构地区：[1]中国医学科学院 [2]北京协和医学院国家心血管病中心 [3]阜外心血管病医院核医学科,北京市100037 [2]阜外心血管病医院放射科 [3]阜外心血管病医院超声科 [4]阜外心血管病医院心内科

出　　处：《中国循环杂志》2015年第4期366-370,共5页Chinese Circulation Journal

基　　金：国家自然基金(NO.81071177);北京市科技计划首都临床特色应用研究(NO.Z131107002213181)

摘　　要：目的:本研究以左心室室壁瘤(LVA)患者为研究对象,旨在比较不同影像学技术,包括门控心肌灌注显像、门控心肌代谢显像、心脏磁共振成像(CMR)、超声心动图测定的心室重构参数对左心室室壁瘤患者心原性死亡的预后价值。方法:经心脏磁共振显像明确诊断的93例左心室室壁瘤患者,在两周内均行锝-甲氧基异丁基异腈(^(90)Tc^m-MIBI)门控单光子发射计算机断层成像术(GSPECT)和^(18)F-FDG门控正电子发射计算机断层扫描(GPET)、心脏磁共振显像和超声心动图检查。GSPECT和GPET均采用定量门控心肌断层软件(QGS)测定左心室射血分数(LVEF)、左心室舒张末期容量(EDV)和左心室收缩末期容量(ESV)。心原性死亡为随访终点。结果:平均随访时间(827±294)天,共12例患者发生心原性死亡。单因素Cox逐步回归法分析,超声心动图测定的心功能参数对死亡无预测价值,GSPECT、GPET以及心脏磁共振显像测定的心室重构参数(EDV和ESV)以及GPET测定的LVEF均为预测心原性死亡的独立危险因子。多因素Cox回归分析,发现GPET测定的ESV[风险比(HR)1.013,95%可信区间(CI):1.003~1.022,P=0.007]是预测心原性死亡的唯一独立危险因子。以GPET测定的ESV 140 nl或EDV180 ml为界值,ESV<140 ml患者的死亡率明显低于ESV≥140 ml患者的死亡率(7.8%vs 24.1%,χ~2=5.156,P=0.023)。EDV<180 rnl患者的死亡率明显低于EDV≥180 ml患者的死亡率(7.1%vs 21.6%,χ~2=4.26,P=0.039)],差异均有统计学意义。结论:GPET对左心室室壁瘤患者测定的心室重构参数(ESV),较其他影像学方法有更高的估测预后的价值。左心室室壁瘤患者如果有严重心室重构(ESV≥140 ml),预后差。因此,对左心室室壁瘤患者应该早期采取积极治疗方法,预防、延缓心室重构的发生和发展,而对已经发生严重心室重构的患者,要采取有效治疗手段,改善或者逆转心室重构,从而改善患者预后。Objective： To comparatively study the prognostic value of left ventricular （LV） remodeling parameters measured by different imaging technologies in patients with LV aneurysm for their cardiac death.Methods： A total of 93 patients with cardiac MR （CMR） conifrmed LV aneurysm were studied. The patients received 99mTc-MIBI GSPECT, 18F-FDG GPET, CMR and echocardiography examination within 2 weeks. GSPECT and GPET were conducted with QGS software to measure LV ejection fraction （LVEF）, LV end-diastolic volume （LVELV） and LVESV. The patients were followed-up for the average of （827 ± 294） days and the endpoint event was deifned by cardiac death. Results： The cardiac death occurrence in 12 patients. Univariate Cox hazard regression analysis presented that echocardiography measured parameters had no predictive value for cardiac death;GSPECT, GPET and CMR measured parameters of LVEDV, LVESV and GPET measured LVEF were the independent risk factors for predicting the cardiac death. Multivariate Cox hazard analysis showed that GPET measured LVESV was the only independent predictor for cardiac death （HR=1.013, 95%CI 1.003-1.022, P=0.007）. Taking GPET measured LVESV at 140 ml or LVEDV at 180 ml as the cut-off value, the patients with LVESV〈140 ml had much lower mortality than those with LVESV≥140 ml （7.8% vs 24.1%, χ^2= 5.16, P=0.023）, and the patients with LVEDV〈180 ml had much lower mortality than those with LVEDV≥180 ml （7.1%vs 21.6%,χ^2=4.26, P=0.039）. Conclusion： GPET measured LVESV had the higher prognostic value than the other imaging technologies in aneurysm patients. The patients with severe LV remodeling （ESV≥140 ml） had poor prognosis. It is important to keep alert for aneurysm in clinical practice.

关 键 词：室壁瘤 左心室重构 门控正电子发射断层成像术 预后 

分 类 号：R54[医药卫生—心血管疾病]