^(18)F-氟脱氧葡萄糖正电子发射断层扫描/CT心肌代谢显像右心室显影对缺血性心力衰竭的预后价值  

Prognostic Value of Right Ventricular Glucose Metabolism Assessed by^(18)F-fluorodeoxyglucose Positron Emission Tomoqraphy/CT Imaging in Patients With Ischemic Heart Failure

作　　者：郑雅琦 焦建[1] 贠明凯 孟晶晶[1] 田晶 白玉洁 解小芬[1] 皮颖斐[1] 田毅 杨秀滨 来永强[1] 董然[1] 张晓丽[1] ZHENG Yaqi;JIAO Jian;YUN Mingkai;MENG Jingjing;TIAN Jing;BAI Yujie;XIE Xiaofen;PI Yingfei;TIAN Yi;YANG Xiubin;LAI Yongqiang;DONG Ran;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、分子影像实验室、核医学科,北京市100029

出　　处：《中国循环杂志》2023年第3期299-305,共7页Chinese Circulation Journal

基　　金：国家自然科学基金面上项目(81871377);国家自然科学基金面上项目(82171994);北京市医管局扬帆计划重点医学专业(ZYLX202110)。

摘　　要：目的:探讨^(18)F-氟脱氧葡萄糖(FDG)正电子发射断层扫描(PET)/CT心肌代谢显像右心室显影对缺血性心力衰竭(IHF)预后的价值。方法:回顾性收集2016年4月至2019年2月在我院行^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)单光子发射计算机断层(SPECT)门控心肌灌注显像(G-MPI)和门控^(18)F-FDG PET/CT心肌代谢显像的冠心病患者,其中合并重度IHF[G-MPI测得左心室射血分数(LVEF_(G-MPI))≤35%]患者纳入本研究,334例患者经倾向性评分匹配后,最终纳入173例重度IHF患者。根据视觉评估右心室是否显影,将患者分为右心室未显影组(n=132)和右心室显影组(n=41)。采用目测评分法评估右心室显影情况(包括右心室心腔大小与右心室对^(18)F-FDG的摄取程度),总分值越高,提示右心室显影的异常程度越重。测定右心室显影患者的右心室游离壁心肌平均标准化摄取值(SUV-RV)和左心室游离壁心肌平均标准化摄取值(SUV-LV),计算两者比值(SUV-R/L)。对患者进行随访,随访终点为复合终点包括全因死亡、接受心脏移植以及安装左心辅助装置。Cox回归分析预测复合终点的影响因素。采用Kaplan-Meier方法获得生存曲线,并用log-rank检验比较率的差异。结果:173例重度IHF患者中,男性155例(89.6%),年龄为(55.2±8.8)岁。随访时间为44.0(36.2,52.1)个月,5例(2.9%)患者接受心脏移植,38例(22.0%)患者发生全因死亡。右心室显影评分与SUV-R/L呈强正相关(r=0.555,P=0.001),与肺动脉收缩压(SPAP)呈中等正相关(r=0.487,P<0.001)。Kaplan-Meier生存曲线分析显示,右心室显影组无事件生存率明显低于右心室未显影组[(52.6±8.0)%vs.(67.8±8.8)%,P<0.001]。Cox多因素回归分析显示,年龄(HR=1.067,95%CI:1.020~1.116,P=0.005)、血运重建术(HR=0.171,95%CI:0.058~0.505,P=0.001)和右心室显影评分(HR=1.194,95%CI:1.011~1.410,P=0.037)是复合终点的独立影响因素。结论:在IHF患者中,^(18)F-FDG PET/CT心肌代谢显像右心室心�Objectives:To investigate the prognostic value of right ventricular glucose metabolism assessed by^(18)F-fluorodeoxyglucose(FDG)positron emission tomography(PET)/CT myocardial imaging in patients with ischemic heart failure(IHF).Methods:Patients with coronary artery disease,who underwent gated^(99)Tc^(m)-methoxyisobutyl isonitrile(MIBI)single photon emission computed tomography(SPECT)myocardial perfusion imaging(G-MPI)and gated^(18)F-FDG PET/CT myocardial metabolic imaging between April 2016 and February 2019 and with severe IHF(left ventricular ejection fraction[LVEF]G-MPI≤35%),were enrolled in this study.According to the size of right ventricle(RV)and the^(18)F-FDG uptake activity of RV,visual score analysis was performed and patients were divided into RV imaging positive group and RV imaging negative group.The higher the total score is,the greater is the degree of abnormality in RV.The mean standardized uptake value of right ventricular free wall(SUVRV)and left ventricular free wall(SUV-LV)was measured in RV imaging positive group,and their ratio(SUV-R/L)was calculated.The endpoint was a composite outcome of all-cause death,left ventricular assist device implantation,and heart transplantation.Cox regression analysis was used to identify the independent predictors of the composite endpoint.Survival curves were obtained by the Kaplan-Meier method and compared with the log-rank test.Results:After propensity score matching of 334 patients,173 IHF patients(LVEF_(G-MPI)≤35%)were finally included[155(89.6%)men,mean age(55.2±8.8)years].During follow-up[44.0(36.2,52.1)months],5(2.9%)patients underwent heart transplantation and all-cause deaths occurred in 38(22.0%)patients.None received left ventricular assist device.Right ventricular score was positively correlated with SUV-R/L(r=0.555,P=0.001)and pulmonary artery systolic pressure(SPAP)(r=0.487,P<0.001).The survival rate in RV imaging positive group was significantly lower than that in RV imaging negative group(P<0.001).Cox multivariate regression analysis showe

关 键 词：正电子发射断层显像 缺血性心力衰竭 右心室 预后 危险分层 

分 类 号：R54[医药卫生—心血管疾病]