门控心肌灌注显像左心室收缩同步性分析对老年冠心病患者主要心脏不良事件的预测价值  

The predictive value of left ventricular systolic synchrony based on gated myocardial perfusion imaging for major adverse cardiovascular events in elderly patients with coronary heart disease

作　　者：李旭[1] 罗诗雨 刘甫庚[1] 陈聪霞[1] 郭悦[1] 秦嵩[1] 王华[3] 姚稚明[1] Li Xu;Luo Shiyu;Liu Fugeng;Chen Congxia;Guo Yue;Qin Song;Wang Hua;Yao Zhiming(Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Cardiology,Beijing Hospital,National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院核医学科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]首都医科大学附属北京同仁医院核医学科,北京100730 [3]北京医院心内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2024年第7期834-840,共7页Chinese Journal of Geriatrics

基　　金：首都卫生发展科研专项(重点)(2022-1-4052)。

摘　　要：目的探讨门控心肌灌注显像(GMPI)左心室收缩同步性分析对老年冠心病患者主要心脏不良事件(MACE)的预测价值。方法回顾性分析北京医院2012年9月至2014年2月完成两日法静息-负荷GMPI检查的老年患者的临床资料、GMPI测得的心肌灌注总负荷积分(SSS)、左心室射血分数(LVEF)和高峰充盈率(PFR)、相位分析参数之相位直方图带宽(PBW)、相位标准差(PSD)、相位熵(PE),并随诊MACE发生情况。采用多因素Cox比例风险回归模型分析MACE的独立危险因素,用Kaplan-Meier生存曲线分析累积MACE发生率。结果共纳入受检者427例,男性200例(46.8%),年龄60~92(74.1±6.5)岁,中高龄老年人(≥70岁)占75.6%(323例)。中位随访54.7个月,47例(11.0%)发生MACE。和无MACE组比较,MACE组高血压、高脂血症、高尿酸发生率显著增高(χ^(2)=5.20、5.62、3.86,均P<0.05),LVEF和PFR显著降低(t=-5.51、-5.23,均P<0.001),SSS、PSD、PBW、PE显著增高(Z=4.78,t=5.14、5.78、5.62,均P<0.001)。中高龄、灌注异常、PSD增高、PE增高是MACE发生的独立危险因素[HR值分别为2.57(95%CI:1.08~6.13)、2.60(95%CI:1.31~5.15)、3.72(95%CI:1.72~8.05)、4.09(95%CI:1.94~8.63),均P<0.05]。进一步在323例中高龄老年人中分析证实,灌注异常、PSD增高、PE增高也是发生MACE的独立危险因素[HR值分别为2.96(95%CI:1.40~6.26)、3.51(95%CI:1.56~7.89)、4.49(95%CI:2.08~9.71),均P<0.05]。结论GMPI左心室收缩同步性分析参数能很好地识别老年冠心病患者中MACE高风险人群。Objective To investigate the value of left ventricular systolic synchrony assessed by gated myocardial perfusion imaging(GMPI)in predicting major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD).Methods In this retrospective study,clinical data from elderly patients who had completed a two-day assessment of resting-loading GMPI between September 2012 and February 2014 in Beijing Hospital were collected,including the summed stress score(SSS)for total ischemic burden,measured by GMPI,left ventricular ejection fraction(LVEF),peak filling rate(PFR),phase band width(PBW),phase standard deviation(PSD)and phase entropy(PE).Follow-up of MACE was conducted.Independent risk factors for MACE were analyzed using a multifactorial Cox proportional hazards regression model,and the cumulative MACE incidence was analyzed using the Kaplan-Meier survival curve.Results A total of 427 subjects were enrolled,including 200(46.8%)men,with a mean age of 74.1±6.5(60-92)years and 323(75.6%)aged≥70 years.The median follow-up time was 54.7 months.At the end of follow-up,MACE occurred in 47 patients(11.0%).Compared with the group without MACE,the incidences of hypertension,hyperlipidemia,and hyperuricemia were significantly higher(χ^(2)=5.20,5.62,3.86,all P<0.05),LVEF and PFR were significantly lower(t=-5.51,-5.23,both P<0.001),and SSS,PSD,PBW,and PE were significantly higher(Z=4.78,t=5.14,5.78,5.62,all P<0.001)in the MACE group.The results of Cox proportional hazards regression model analysis suggested that age≥70(hazard ratio:2.57,95%CI:1.08-6.13),abnormal perfusion(hazard ratio:2.60,95%CI:1.31-5.15),increased PSD(hazard ratio:3.72,95%CI:1.72-8.05)and increased PE(hazard ratio:4.09,95%CI:1.94-8.63)were independent risk factors for the occurrence of MACE(all P<0.05).Further analysis on 323 patients≥70 years indicated that abnormal perfusion(hazard ratio:2.96,95%CI:1.40-6.26),increased PSD(hazard ratio:3.51,95%CI:1.56-7.89),and increased PE(hazard ratio:4.49,95%CI:2.08-9.71)were independent risk

关 键 词：冠心病 预后 体层摄影术 发射型计算机 单光子 心肌灌注显像 

分 类 号：R541.4[医药卫生—心血管疾病] R817.4[医药卫生—内科学]