负荷动态CT心肌灌注成像对疑似冠心病患者的预后价值  

Prognostic assessment of stress dynamic CT myocardial perfusion imaging in patients with suspected coronary artery disease

作　　者：刘庆爽 杨志强[1] 贾崇富[1] 孙喜霞[1] 王照谦[1] LIU Qing-shuang;YANG Zhi-qiang;JIA Chong-fu(Department of Cardiovascular Radiology,the First Hospital of Dalian Medical University,Liaoning 116011,China)

机构地区：[1]大连医科大学附属第一医院心血管放射科,辽宁大连116011 [2]浙江省舟山医院放射诊断中心,浙江舟山316004

出　　处：《放射学实践》2025年第3期356-361,共6页Radiologic Practice

摘　　要：目的:探讨腺苷负荷动态CT心肌灌注成像(CT-MPI)对疑似冠心病患者主要不良心血管事件(MACE)的预测价值。方法:回顾性纳入193例疑似冠心病(CAD)患者。冠状动脉CT血管造影(CCTA)和CT-MPI均使用第三代双源CT扫描仪。主要终点是随访自CT-MPI检查后至首次发生MACE的时间。采用单因素和多因素COX比例风险回归分析评价MACE的预测因素。将单因素COX比例风险回归分析中差异有统计学意义的变量纳入多因素COX比例风险回归模型,通过计算受试者操作特征(ROC)曲线下面积(AUC)及各模型整体卡方评分,评价三个模型对MACE的预测价值。模型1:血脂异常;模型2:模型1+CCTA≥50%狭窄;模型3:模型2+CT-MPI≥1个心肌节段低灌注。结果:中位随访时间为34.0(21.4~41.6)个月。25例患者发生MACE,其中心源性死亡2例,非致命性心肌梗死2例;不稳定性心绞痛18例,接受晚期(≥90天)血运重建3例。多因素COX比例风险回归分析显示CT-MPI≥1个心肌节段低灌注(HR:8.37,95%CI:1.96~35.74,P=0.004)是MACE的独立预测因子。将CT-MPI≥1个心肌节段低灌注加入模型2时,AUC值由0.72升至0.80(95%CI:0.74~0.86)(模型2 vs.模型3,P=0.011),整体卡方评分从10.81显著升至25.20。结论:联合CT-MPI比单独的心血管风险因素或仅与CCTA联合具有更高的预后价值。Objective:To investigate the predictive value of dynamic stress CT myocardial perfusion imaging(CT-MPI)for major adverse cardiac events(MACE)in patients with suspected coronary artery disease.Methods:193 patients with suspected coronary artery disease were retrospectively included.CCTA and CT-MPI images were acquired using third-generation dual-source CT.The primary endpoint was the time from CT-MPI examination to the first MACE.Univariate and multivariate COX proportional hazard regression analyses were used to evaluate the predictive factor of MACE.Statistically significant variables in univariate COX proportional hazard regression analysis were included in the multivariate COX proportional hazard regression model.The predictive values of three models for MACE were evaluated by calculating the area under curve(AUC)and the overall Chi-square score of each model.Models were classified as:Model 1,dyslipidemia;Model 2,mode 1+CCTA≥50%stenosis;Model 3,mode2+CT-MPI≥1 myocardial segment hypoperfusion.Results:The median follow-up time was 34.0(21.4~41.6)months.MACE were occurred in 25 patients,including 2 with cardiac deaths and 2 with nonfatal myocardial infarctions,18 with unstable angina,and 3 late coronary revascularization(≥90 days).Multivariate COX proportional hazard regression analysis showed that CT-MPI≥1 myocardial segment hypoperfusion(HR:8.37,95%CI:1.96~35.74,P=0.004)was an independent predictor of MACE.When CT-MPI≥1 myocardial segment hypoperfusion was added to Model 2,the AUC value increased from 0.72 to 0.80(95%CI:0.74~0.86)(Model 2 vs.Model 3,P=0.011),the overall Chi-square score of models increased significantly from 10.81 to 25.20.Conclusion:Combined CT-MPI has a higher prognostic value than either isolated cardiovascular risk factors or combination with CCTA alone.

关 键 词：冠状动脉血管造影 CT心肌灌注成像 冠心病 主要不良心血管事件 预后 

分 类 号：R814.42[医药卫生—影像医学与核医学] R541.4[医药卫生—放射医学]