^18F-氟代脱氧葡萄糖心肌代谢显像探测左心室室壁瘤的存活心肌及其合并室性心律失常对患者长期预后的影响  

Long-term Prognosis in Patients With Viable Myocardium in Left Ventricular Aneurysm and Arrhythmia Asseeed by ^(18)F-FDG Imaging

作　　者：杨易剑 侯翠红[2] 田丛娜[3] 王伟学[1] 魏红星[1] 赵敏[4] 郭风[1] 褚克维[1] 耿庆海[1] 王琦[1] 姜楠[1] 张宗耀[1] 张利霞[1] 张健[5] 田月琴[1] 张晓丽[1] 刘秀杰[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院核医学科,北京市100037 [2]北京协和医学院中国医学科学院国家心血管病中心阜外医院心律失常诊治中心,北京市100037 [3]河北省人民医院核医学科 [4]山东省淄博市中心医院核医学科 [5]北京协和医学院中国医学科学院国家心血管病中心阜外医院心力衰竭诊治中心,北京市100037

出　　处：《中国循环杂志》2015年第12期1152-1156,共5页Chinese Circulation Journal

基　　金：国家自然基金资助项目(81071177);北京市科技计划首都临床特色应用研究(Z131107002213181)

摘　　要：目的:评估左心室室壁瘤部位存活心肌和室性心律失常对室壁瘤患者预后的影响。方法:研究纳入160例左心室室壁瘤患者。所有患者均行^(99)Tc^m-甲氧基异丁基异腈(MIBI)心肌灌注显像和门控^(18)F-氟代脱氧葡萄糖(FDG)心肌代射显像。定量门控心肌断层软件获得患者左心室功能参数,包括舒张末期容积(EDV)、收缩末期容积(ESV)、左心室射血分数(LVEF)。对心肌灌注和代谢显像图像半定量分析,获得心肌灌注和代谢的异常分,以及灌注-代谢不匹配分(MMS)。室壁瘤部位MMS≥2.0,定义为室壁瘤部位有存活心肌。160例患者根据室壁瘤部位心肌存活情况分为无心肌存活组(n=97)和有心肌存活组(n=63),两组患者进一步根据是否合并室性心律失常分为4个亚组:无心肌存活且无室性心律失常为组1(n=68)、无心肌存活且有室性心律失常为组2(n=29)、有心肌存活且无室性心律失常患者为组3(n=50)、有心肌存活且有室性心律失常患者为组4(n=13)。平均随访(50±7)个月,心原性死亡为随访终点。Kaplan-Meier方法获得生存曲线,并用Log-rank法比较率的差异。结果:160例患者的平均LVEF为(34±11)%。共19例(11.9%)患者发生心原性死亡。组1患者的长期生存率达94.1%,但是与组2(89.7%)、组3(86.0%)的生存率相比,差异无统计学意义(P>0.05)。组4的生存率(61.5%)明显低于其他3组(P=0.004)。多因素Cox回归分析显示:女性[风险比(HR)=5.101,95%可信区间(CI):1.853~14.044,P=0.002]、门控正电子发射计算机断层扫描(GPET)-ESV(HR=1.009,95%CI:1.002~1.015,P=0.013)、室壁瘤部位MMS与室性心律失常交互作用(HR=1.368,95%CI:1.113~1.681,P=0.003)是心原性死亡的独立危险因素,而手术治疗(HR=0.199,95%CI:0.054~0.742,P=0.016)则降低心原性死亡风险。结论:室壁瘤患者如果室壁瘤部位有存活心肌合并室性心律失常为高危患者,需要对这类患者早期采取积极治疗措施(手术+纠正室性心�Objective： To assess the impact of viable myocardium in left ventricular aneurysm （LVA） and ventricular arrhythmia on prognosis of LVA patients. Methods： A total of one hundred and sixty LVA patients who received ^99Tc^m-MIBI SPECT and ^18F-FDG PET were enrolled, including 139 male and 21 female with the mean age of （58±10） years.There were 42 （26.3%） patients combining ventricular arrhythmia. LVEDV, LVESV and LVEF were detected. Semi-quantitative analysis of myocardium perfusion imaging was conducted, viable myocardium in aneurysm was defined as the perfusion-metabolism mismatch score （MMS） 〉 2.0. According to myocardium viability, the patients were divided into 2 groups： No viability group, n=97 and With viability group, n=63; based on ventricular arrhythmia, the patients were divided into another 4 groups： Group ①, viability-, ventficular arrhythmia-, n=68, Group ②, viability-, ventricular arrhythmias＋, n=29, Group ③, viability＋, ventricular arrhythmias-, n=50 and Group @, viability＋,ventricular arrhythmias＋, n=13. The average follow-up time was （50±7） months, the end point was cardiac death. The survival curve was obtained by Kaplan-Meier method and survival rates were compared by Log-rank analysis. Results： The mean LVEF in 160 patients was （34±11） %, cardiac death occurred in 19 （11.9%） patients. Long-term survival rates in Groups ①, ② and ③ were 94.1%, 89.7% and 86.0%, respectively, P〉0.05; while in Group ④, the survival rate was 61.5%, which was lower than the other 3 groups, P=0.004. Multivariate Cox regression analysis showed that female （HR=5.101, 95% CI 1.853-14.044, P=0.002）, GPET-ESV （HR=1.009, 95% CI 1.002-1.015, P=0.013）, interaction between MMS and ventricular arrhythmia （HR=1.368, 95%CI 1.113-1.681, P=0.003） were independent risk factors for cardiac death; while surgical treatment （HR=0.199, 95% CI 0.054-0.742, P=0.016） could decrease the risk of cardiac death. Conclusion： Patients with viable aneurysm and ve

关 键 词：心脏室壁瘤 存活率 放射性核素显像 

分 类 号：R54[医药卫生—心血管疾病]