18F-FDG PET／CT心肌代谢显像和侧支循环形成对于冠状动脉慢性闭塞性病变心功能预后价值的比较分析  

Comparison of prognostic value of 18F-FDG PET/CT myocardial metabolism imaging and coronary collateral circulation in patients with CTO lesions

作　　者：翟光耀[1] 王建龙[1] 刘宇扬[1] 周玉杰[1] Zhai Guangyao;Wang Jianlong;Liu Yuyang;Zhou Yujie(The 12th Ward, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院心内12病房,100029

出　　处：《中华医学杂志》2018年第17期1342-1346,共5页National Medical Journal of China

基　　金：国家重点研发计划“精准医学研究”重点专项（2017YFC0908800）;北京市医管局“登峰”计划（DFL20150601）;北京市医院管理局临床医学发展专项经费（ZYLX201303）

摘　　要：目的比较18F脱氧葡萄糖（18F—FDG）PET／CT心肌葡萄糖代谢显像与侧支循环形成对于评价冠状动脉慢性闭塞性病变（CTO）患者心功能预后价值。方法收集2016年4月至2017年4月在北京安贞医院就诊的CTO患者60例，1周内完成99mTc甲氧基异丁基乙腈（99mTc-MIBI）静息门控心肌灌注单光子发射计算机断层扫描（SPECT）／CT（GSPECT）显像和18F—FDG门控心肌葡萄糖代谢正电子发射计算机断层扫描（PET）／CT显像（GPET），评价存活心肌及左心室功能，冠状动脉造影检测评价CTO病变的位置及侧支循环形成。GPET数据采用定量门控心脏断层软件QGS分析，获取左心室功能参数，包括舒张末期容积（EDV），收缩末期容积参数（ESV）和左心室射血分数（LVEF）。侧支循环形成的程度应用Rentrop分级评价。全部入选研究对象随访12～20个月，以美国纽约心脏病学会（NYHA）心功能分级评估心功能，比较18F—FDGPET／CT心肌葡萄糖代谢显像与侧支循环形成对于CTO患者心功能预后的价值。结果CTO患者随访NYHA心功能变化，失访7例，最终纳入本研究53例患者，年龄36～70（57±11）岁，男50例、女3例。依据NYHA心功能分级，将心功能改善和无变化的患者定义为无进展组，将随访后心功能恶化的患者定义为进展组，发现两组患者之间年龄、冠心病高危因素及临床用药差异均无统计学意义。心功能无进展组患者的LVEF明显高于心功能进展组（42．3％±17．2％比22．2％±10．4％，P〈0．01）。心功能进展组患者发生明显的左心室重构，ESV[（212±117）ml比（92±76）ml，P〈0．01]和EDV[（263±117）ml比（149±81）ml，P〈0．01]均明显大于心功能无进展组患者。以18F-FDGPET／CT心肌葡萄糖代谢显像综合指标评价CTO病变患者的预后，敏感度（95．2％比75．7％）、特异度（62．8％比38．1％）和诊断符合率（90．2％比68Objective To evaluate the location, extent of viable myocardial of chronic total coronary occlusions（CTO） lesions by 18F-FDG PET myocardial metabolism imaging and then compare with coronary collateral circulation （CCC） to evaluate the prognostic evaluation in patients with CTO lesions. Methods A total of Sixty consecutive patients with CTO lesions referred for viability assessment from April 2016 to April 2017 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. These patients underwent 99mTe-sestamibi ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated 18F-FDG PET/CT myocardial metabolic imaging, as well as coronary arteriography were recruited in this study. LV functional parameters（EDV, ESV, and LVEF） were analyzed by QGS software. The extent of CCC to the area of CTO related artery was graded as poorly, or well developed collaterals, assessed by Rentrop classification. All patients were followed up for a median of 17 months（range 12 -20 months） and evaluated the changes of NYHA. Then the prognostic value of 18F-FDG PET myocardial metabolism imaging and CCC in patients with CTO lesions were analyzed and evaluated. Results As the standard evaluation of NYHA in patients with CTO lesions after 12 -20 months, fifty-three patients were assigned in this study. According to the changes of NYHA, the patients were divided into no progress group and progress group. There were no statistically difference in age, gender, high risk of CTO lesion and drugs in two groups, but there were significant statistical differences in myocardial parameters. LVEF was significantly increased in patients with CTO lesion in no progress group（42. 3%±17. 2% vs 22. 2% ± 10. 4% ,P 〈0. 01 ）. The EDV and ESV in no progress group were significantly smaller than patients in progress group. The sensitivity （95.2% vs 75.7% ） and specificity（62. 8% vs 38.1% ） of 18F-FDG PET myocardial metabolism imaging was much better than CCC in the evaluation of prognosis in patients with CTO

关 键 词：冠状动脉疾病 侧支循环 正电子发射断层显像术 

分 类 号：R543.3[医药卫生—心血管疾病]