心肺运动试验联合心肌灌注显像预测围术期心血管不良事件发生风险  

Cardiopulmonary exercise testing combined with myocardial perfusion imaging predicts the risk of perioperative cardiovascular adverse events

作　　者：郑树斌 平伟 王麒 张瑞杰[1] 孙启航 刘常宇 吴晓伟 张霓[1] ZHENG Shubin;PING Wei;WANG Qi;ZHANG Ruijie;SUN Qihang;LIU Changyu;WU Xiaowei;ZHANG Ni(Dept.of Thoracic Surgery,Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,湖北武汉430030

出　　处：《武汉大学学报(医学版)》2025年第3期370-374,共5页Medical Journal of Wuhan University

基　　金：湖北省陈孝平科技发展基金(编号:CXPJJH122001-2226)。

摘　　要：目的:探讨心肺运动试验(CPET)和心肌灌注显像(MPI)联合应用于重大非心脏手术术前预测高危冠状动脉(冠脉)疾病患者围术期主要心血管不良事件(MACE)发生率的可行性。方法:回顾分析了61位接受重大非心脏手术的高危冠脉疾病患者,这些患者在手术前接受了CPET及MPI,观察他们在围术期MACE发生情况,包括新发心律失常、充血性心力衰竭、急性心肌梗死(AMI)、狭窄冠脉的血运重建、非致死性心脏骤停、心源性死亡。结果:在61位患者中,有25位患者术前行冠脉CT血管造影检查发现至少有一支冠脉狭窄程度超过70%,36位患者冠脉的狭窄程度均不超过70%;而经CPET及心肌灌注显像评定为高风险的患者有5位[峰值摄氧量≥15~<20 mL·min^(-1)·kg^(-1)且MPI提示心肌轻度缺血,或峰值摄氧量<15 mL·min^(-1)·kg^(-1)],其余56位患者均为低风险。两项检查评估结果与冠脉狭窄程度无明显一致性(P>0.05)。术后仅有3位患者至少发生了一次MACE,1位患者在围术期出现了急性心肌梗死并在术后接受了冠脉的血运重建,1位患者出现了充血性心力衰竭,1位患者出现了新发心律失常,没有死亡病例。其中高风险组中有1位患者被诊断为围术期急性心肌梗死,并接受了冠脉介入治疗;2位低风险组患者在围术期分别出现了心力衰竭和心律失常的情况。结论:心肺运动试验和心肌灌注显像用于重大非心脏手术前评估高危冠脉疾病患者的心功能,预测围术期心血管事件的发生风险是可行的。但由于样本量较小,该研究结果需要进一步探索。Objective:To analyze and assess the feasibility of combined application of Cardiopulmonary Exercise Testing(CPET)and Myocardial Perfusion Imaging(MPI)for predicting the perioperative main adverse cardiovascular events(MACEs)rate in high-risk coronary artery disease patients before major non-cardiac surgery.Methods:We reviewed 61 patients with high-risk coronary artery who underwent a major non-cardiac surgery.Both CPET and MPI were preoperatively applied,which did not suggest exact myocardial ischemia.MACEs were observed in their perioperative period,which include new-onset arrhythmias,congestive heart failure,acute myocardial infarction(AMI),coronary artery revascularization for narrowed vessels,non-lethal cardiac arrest,and cardiac death.Results:Among the 61 patients,25 patients were found at least one of the coronary arteries with stenosis degree exceeding 70%based on coronary computed tomographic angiography(CTA),while 36 patients were found all coronary arteries with stenosis degree below 70%.There were 4 patients assessed as high risk by CPET and MPI(peakVO2≥15-<20 mL·min^(-1)·kg^(-1)and MPI indicating mild myocardial ischemia,or peakVO2<15 mL·min^(-1)·kg^(-1)),and the remaining 57 patients were considered at low risk.There was no significant consistency between the results of the two examinations and the degree of coronary stenosis(P>0.05).Postoperatively,at least one MACE happened in only three patients,with one patient experiencing acute myocardial infarction and undergoing coronary revascularization,one patient developing congestive heart failure,and one patient having new-onset arrhythmia.No death case were found.Among the high-risk group,one patient was diagnosed with perioperative acute myocardial infarction and underwent coronary intervention,while two patients in the low-risk group experienced heart failure and arrhythmia during the perioperative period,respectively.Conclusion:The application of Cardiopulmonary Exercise Testing and Myocardial Perfusion Imaging for preoperative assessment of c

关 键 词：心肺运动试验 心肌灌注显像 非心脏手术 心肌缺血 

分 类 号：R619[医药卫生—外科学]