门控心肌灌注显像预测纯合子家族性高胆固醇血症患者主要心脏不良事件的研究  

Gated myocardial perfusion imaging for the prediction of major adverse cardiac events in patients with homozygous familial hypercholesterolemia

作　　者：焦建[1] 董薇[1] 常智 张颖[1] 李全[1] 李珺奇[1] 米宏志[1] JIAO Jian;DONG Wei;CHANG Zhi;ZHANG Ying;LI Quan;LI Junqi;MI Hongzhi(Department of Nuclear Medicine,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-北京市心肺血管疾病研究所核医学科,100029

出　　处：《心肺血管病杂志》2024年第6期623-628,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:通过负荷+静息门控心肌灌注显像(gated myocardial perfusion imaging,G-MPI)评价纯合子家族性高胆固醇血症(homozygous familial hypercholesterolemia,HoFH)患者主要心脏不良事件(major adverse cardiovascular events,MACE)的预测价值。方法:对经临床和基因诊断确诊HoFH,在2010年6月至2022年3月,于我院行负荷+静息G-MPI检查的患者进行回顾性随访。图像分析采用17节段5分法,获得左心室心肌血流灌注及功能参数。随访患者MACE,采用Cox回归分析与MACE有关的预测因子。通过ROC分析预测因子的效能,采用Kaplan-Meier法和Log-rank检验比较不同组HoFH患者MACE发生率的差异。结果:共入选59例HoFH患者,中位随访时间6(4,9)年。随访期间20例(20/59,33.9%)患者出现MACE。G-MPI参数负荷灌注总积分(summed stress score,SSS)、静息灌注总积分(summed rest score,SRS)、总积分差值(summed difference score,SDS)、负荷左心室收缩末期容积(stress end-systolic volume,SESV)、负荷左心室射血分数(stress ejection fraction,SEF)、静息左心室收缩末期容积(rest end-systolic volume,RESV)、静息左心室射血分数(rest ejection fraction,REF)在MACE组与无MACE组,差异有统计学意义(P<0.05)。Cox回归分析显示SSS(HR=1.18,95%CI:1.088~1.279,P<0.001)是与HoFH患者出现MACE的独立预测因子。通过ROC分析确定预测HoFH患者出现MACE的SSS最佳截断值为5.5(AUC=0.813,95%CI:0.682~0.945,P<0.001),SSS≥5.5组MACE发生率明显高于SSS<5.5组(69.2%vs.15.0%,χ^(2)=27.085,P<0.001)。结论:负荷+静息G-MPI是对HoFH患者进行MACE评估的重要影像学手段,参数SSS是预测患者出现MACE的重要因素。Objective:To evaluate the predictive value of major adverse cardiovascular events(MACE)by stress and rest gated myocardial perfusion imaging(G-MPI)in patients with homozygous familial hypercholesterolemia(HoFH).Methods:Patients with HoFH diagnosed clinically and genetically and who underwent stress and rest G-MPI from June 2010 to March 2022 at our hospital were retrospectively followed up.Image analysis was performed using a 17-segment 5-point method to obtain left ventricular myocardial perfusion and functional parameters.Patients were followed up for MACE,and predictors related to MACE were analyzed by Cox regression.The efficacy of predictors was analyzed by ROC,and the Kaplan-Meier method and log-rank test were used to compare the differences in the incidence of MACE in different groups of HoFH patients.Results:A total of 59 HoFH patients were enrolled with a median follow-up of 6(4,9)years.MACE occurred in 20(20/59,33.9%)patients during the follow-up period.The differences in G-MPI parameters SSS,SRS,SDS,SESV,SEF,RESV,and REF were statistically significant between the MACE group and the non-MACE group(P<0.05).Cox regression analysis showed that the SSS(HR=1.18,95%CI:1.088-1.279,P<0.001)was an independent predictor associated with the development of MACE in HoFH patients.The optimal cut-off value of SSS for predicting MACE in HoFH patients was determined to be 5.5 by ROC analysis,with the AUC of 0.813(95%CI:0.682-0.945,P<0.001).The incidence of MACE in the group with SSS≥5.5 was significantly higher than that in the group with SSS<5.5(69.2%vs.15%;χ^(2)=27.085,P<0.001).Conclusions:Stress and resting G-MPI is an important imaging tool for MACE assessment in patients with HoFH,and the parameter SSS is an important factor in predicting MACE in HoFH patients.

关 键 词：纯合子家族性高胆固醇血症 门控 心肌灌注显像 主要心脏不良事件 

分 类 号：R54[医药卫生—心血管疾病]