运动-静息心肌灌注显像对冠心病病人心脏事件发生的预测价值

Prognostic Value of Stress-rest Myocardial Perfusion Imaging for Coronary Artery Disease

目的评价运动～静息心肌显像中不同显像方式及显像结果异常类型对心脏事件发生的影响。方法追踪了206例行运动-静息（SPECT）心肌灌注显像的病人，随访时间（1-56）个月，随访间期为（33．25±14．95）个月，出现心脏事件终止随访，未发生心脏事件者随访皆大于18个月。心脏事件包括心源性死亡、非致死性心肌梗死或梗死面积扩大及再血管化治疗。结果约206例在一周内经历运动-静息心肌显像，正常组133例，可逆性灌注缺损组20例，不可逆性灌注缺损组51例，心脏事件发生率分别为1．5％，65．0％，7．8％，经多样本率两两比较的f分割法分析可逆性灌注缺损灌注组心脏事件发生率与正常组和不可逆性灌注缺损组差别有统计学意义（P〈0．01250），而后两组间无统计学意义（P〉0．01250）。用Kaplan～Meier生存曲线分析3组累积未发生心脏事件率曲线，3组间差别有统计学意义（x^2=124．89，P〈0．001），其中可逆性灌注缺损组预后最差；不同显像方式中，静息与运动方式均阴性或均阳性对心脏事件的发生有显著差异（x^2值分别为8．94和5．80，P〈0．05）。结论运动一静息心肌灌注显像示可逆性灌注缺损是估测心脏事件发生的良好指标，运动显像阴性的病人心脏事件的发生率低于静息显像阴性者。

Objective To evaluate the impact of stress-rest myocardial perfusion imaging（MPI） on cardiac events （CE） in patients （pts） with coronary artery disease. Methods All pts underwent stress- rest myocardial per＇fusion imaging （two days protocol）. The mean interval of following up was 33.25 ± 14.95（ 1 -56）months. Death due to primary cardiac cause, or nonfatal acute myocardial infarction and revascularizafion were considered as CE. Results Based on MPI data, 206 pts were categorized as MPI normal group （ n = 133）, MPI fixed defect group（ n = 51 ）, and MPI reversible defect group（ n = 20）. There were 2 CE in normal MPI group, 13 CE in reversible defects group （ischemic group） and 4 in 51 fixed defects group （infarction group）. The rate of CE occurrence was 1.5%, 65.0% and 7,8% respectively. There was significantly difference between ischemic pts and infarction pts or normal MPI pts group （Fisher＇s Exact Test,P〈0. 001）, but no difference between infarction pts and normal MPI pts group （Fisher＇s Exact Test, P = 0. 050 8）. Conclusion Myocardial ischemia diagnosed by stress - rest myocardial perfusion had higher risk of CE than that in fixed perfusion defects and normal myocardial perfusion. Compared with rest MPI, the stress one was better to evaluate the prognosis in pts with CAD.