SPECT和PET评估冬眠心肌联合心脏磁共振成像测定左心室室壁厚度对缺血性心肌病患者预后的预测价值  

Prognostic Value of Combined Assessment of Hibernating Myocardium by ^(99)Tc^(m)-MIBI SPECT and ^(18)F-FDG PET Imaging and Left Ventricular Wall Thickness by Cardiac Magnetic Resonance Imaging in Patients With Ischemic Cardiomyopathy

作　　者：曹慧晓 孟晶晶[1] 王辉[2] 田晶 张颖[1] 常智 唐立钧[3] 李天女[3] 徐磊[2] 李翔 张晓丽[1] CAO Huixiao;MENG Jingjing;WANG Hui;TIAN Jing;ZHANG Ying;CHANG Zhi;TANG Lijun;LI Tiannyu;XU Lei;LI Xiang;ZHANG Xiaoli(Department of Nuclear Medicine,Laboratory for Molecular Imaging,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核医学科,北京市100029 [2]首都医科大学附属北京安贞医院放射科,北京市100029 [3]南京医科大学第一附属医院核医学科

出　　处：《中国循环杂志》2023年第1期34-40,共7页Chinese Circulation Journal

基　　金：国家自然科学基金(81871377、82171994);扬帆计划重点医学专业(重点培育专业)(ZYLX202110)。

摘　　要：目的:探讨门控^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)单光子发射计算机断层成像(SPECT)和^(18)F-脱氧葡萄糖(FDG)正电子发射断层成像(PET)评估冬眠心肌联合心脏磁共振成像(CMR)测定左心室室壁厚度对缺血性心肌病患者预后的预测价值。方法:回顾性纳入2017年1月至2020年8月于首都医科大学附属北京安贞医院在2周内行门控SPECT、门控PET和CMR检查且诊断为缺血性心肌病的患者75例。图像分析采用17节段法和5分法来评估心肌对显像剂的摄取情况(0分为正常,1分为轻度减低,2分为中度减低,3分为重度减低,4分为缺损),分别获得心肌灌注和心肌代谢异常的总积分,计算二者差值,灌注异常分-代谢异常分≥1分,即心肌灌注-代谢“不匹配”,定义为冬眠心肌。CMR测定的左心室舒张末期室壁厚度<4 mm的心肌节段定义为极薄心肌。根据冬眠心肌范围(冬眠心肌节段占左心室面积的百分比)和极薄心肌节段数,将患者分为四组:A组(冬眠心肌范围≤10%、极薄心肌节段数<2个)、B组(冬眠心肌范围≤10%、极薄心肌节段数≥2个)、C组(冬眠心肌范围>10%、极薄心肌节段数<2个)、D组(冬眠心肌范围>10%、极薄心肌节段数≥2个)。随访终点为全因死亡。采用Cox单因素和多因素模型分析全因死亡的独立危险因素,通过Kaplan-Meier法获得生存曲线,用log-rank检验比较生存率差异。结果:75例患者的平均年龄为(57±10)岁,男性69例(92.0%)。根据冬眠心肌范围和极薄心肌节段数区分,A组、B组、C组、D组分别有13例(17.3%)、14例(18.7%)、21例(28.0%)、27例(36.0%)。中位随访31.0(22.9,37.1)个月,11例(14.7%)患者死亡,A组、B组、C组、D组的累积生存率分别为(100±0)%、(100±0)%、(84.0±8.6)%、(63.5±12.2)%,组间差异有统计学意义(log-rankχ^(2)=9.788,P=0.02)。多因素Cox回归分析显示,冬眠心肌范围联合极薄心肌节段数是预测全因死亡的独立危险因素(HR=3.578,9Objectives:To evaluate the prognostic value of combined assessment of hibernating myocardium(HM)by gated ^(99)Tc^(m)-MIBI SPECT(GSPECT),gated ^(18)F-FDG PET(GPET)and left ventricular wall thickness by cardiac magnetic resonance imaging(CMR)in patients with ischemic cardiomyopathy(ICM).Methods:The study included 75 consecutive patients with ischemic cardiomyopathy,who underwent myocardial viability assessment from January 2017 to August 2020 in Beijing Anzhen Hospital.All patients underwent GSPECT,GPET and CMR within two weeks.Left ventricular end-diastolic wall thickness(EDWT)<4 mm by CMR was defined as thinned myocardium.Perfusion-metabolism mismatch(perfusion score-metabolism score≥1)was considered as HM.Patients were divided into four groups by the extent of HM and thinned myocardium segments:Group A(the extent of HM≤10%and thinned myocardium<2 segments),Group B(the extent of HM≤10%and thinned myocardium≥2 segments),Group C(the extent of HM>10%and thinned myocardium<2 segments),Group D(the extent of HM>10%and thinned myocardium≥2 segments).All-cause death was the primary endpoint.The cumulative survival curve was constructed using the Kaplan-Meier analysis and survival rates were compared with the log-rank test.Cox proportional hazard regression analysis was used to determine the independent predictors for all-cause death.Results:The average age was(57±10)years,69(92.0%)patients were male.According to the extent of HM and thinned myocardium segments,there were 13 cases(17.3%),14 cases(18.7%),21 cases(28.0%)and 27 cases(36.0%)in Group A,Group B,Group C and Group D,respectively.During follow-up 31.0(22.9,37.1)months,11(14.7%)patients died.The survival rates in Group A,Group B,Group C,Group D were(100±0)%,(100±0)%,(84.0±8.6)%,(63.5±12.2)%,respectively,log-rankχ^(2)=9.788,P=0.02.Multivariate Cox regression analysis showed that combination of HM and thinned myocardium segments was the only independent predictor for all-cause death(HR=3.578,95%CI:1.236-10.356,P=0.019).Conclusions:Combined assessment

关 键 词：单光子发射计算机断层成像 正电子发射断层成像 心脏磁共振成像 冬眠心肌 左心室室壁厚度 缺血性心肌病 预后 

分 类 号：R54[医药卫生—心血管疾病]