机构地区:[1]苏州大学附属第三医院、常州市第一人民医院核医学科,213003 [2]苏州大学附属第三医院、常州市第一人民医院心胸外科,213003
出 处:《中华核医学与分子影像杂志》2018年第7期466-470,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging
基 金:国家自然科学基金(81471690);江苏省科技项目(BE2015635);常州市卫生局科技项目(ZD201409);常州市科技支撑.社会发展项目(CE20175029)
摘 要:目的探讨行冠状动脉旁路移植术(CABG)的冠状动脉粥样硬化性心脏病(简称冠心病)患者术前存活心肌及术后左心室机械不同步对术后心脏不良事件(ACE)的预测价值。方法前瞻性纳入2012年9月至2016年3月行CABG的冠心病患者49例[男44例、女5例,平均年龄(64±8)岁],术前进行99Tcm-甲氧基异丁基异腈(MIBI) SPECT门控心肌灌注显像(GMPI)和18F-脱氧葡萄糖(FDG) PET心肌代谢显像评估存活心肌,术后4~6个月复查GMPI,运用GMPI相位分析获得左心室机械不同步参数:相位直方图带宽(BW)及相位标准差(SD)。以ACE作为终点事件进行术后随访。采用Cox回归模型、Kaplan-Meier法和log-rank检验分析数据。结果平均随访(3.82±0.80)年,17例(34.7%,17/49)出现ACE。Cox分析显示术前存活心肌节段数[风险比(HR)=0.208,95% CI:0.068~0.642]、术后BW(HR=1.245,95% CI:1.099~1.411)是冠心病患者CABG术后发生ACE的独立影响因素(均P〈0.01)。Kaplan-Meier生存分析显示存活心肌节段数〈3的患者ACE发生率高于存活心肌节段数≥3者[57.1%(12/21)与17.9%(5/28); χ2=21.023, P〈0.01],术后BW≥98°组患者的ACE发生率高于BW〈98°者[14/19与10%(3/30); χ2=38.395, P〈0.01]。结论术前存活心肌数量少、术后严重左心室机械不同步是冠心病CABG术后发生ACE的独立危险因素。冠心病患者CABG术后左心室机械不同步对预后判断及危险再分层具有重要的临床价值。ObjectiveTo investigate the predictive value of preoperative viable myocardium and postoperative left ventricular mechanical dyssynchrony (LVMD) for adverse cardiovascular events(ACE) after coronary artery bypass graft (CABG) in patients with coronary artery disease (CAD) using myocardial perfusion imaging (MPI).MethodsFrom September 2012 to March 2016, 49 patients (44 males, 5 females, average age: (64±8) years) with CAD were prospectively recruited. All patients underwent 99Tcm-methoxyisobutylisonitrile (MIBI) SPECT gated MPI (GMPI) and 18F-fluorodeoxyglucose (FDG) PET myocardial metabolic imaging to assess myocardial viability preoperatively. GMPI was repeated 4-6 months after CABG to record postoperative LVMD. Phase analysis was used to measure bandwidth (BW) and standard deviation (SD). Regular follow-up was performed, and ACE were taken as the end point. Cox proportional hazard model, Kaplan-Meier method and log-rank test were used to analyze the data.ResultsThe mean duration of follow-up was (3.82±0.80) years, and ACE were present after CABG in 17 CAD patients (34.7%, 17/49). Cox multi-analysis revealed that the number of preoperative viable segments (hazard ratio (HR)=0.208, 95% CI: 0.068-0.642) and postoperative BW (HR=1.245, 95% CI: 1.099-1.411) were independent influencing factors of ACE in CAD patients after CABG (both P〈0.01). Kaplan-Meier survival analysis showed that the incidence of ACE in patients with 〈3 viable segments was significantly higher than those with ≥3 viable segments (57.1%(12/21) vs 17.9% (5/28); χ2=21.023, P〈0.01). The incidence of ACE was significantly higher in the postoperative BW≥98° group than that in the postoperative BW〈98° group (14/19 vs 10%(3/30); χ2=38.395, P〈0.01).ConclusionsLess preoperative viable segments and severe postoperative LVMD are independent risk factors of ACE after CABG in CAD patients. Postoperative LVMD in CAD patients undergoing CABG may
关 键 词:冠状动脉疾病 冠状动脉旁路移植术 非体外循环 预后 体层摄影术 发射型计算机 单光子 正电子发射断层显像术 99M锝甲氧基异丁基异腈 脱氧葡萄糖
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