左室腔与心肌计数比值对心肌梗塞患者预后的预测价值

Prediction value of the left ventricular cavity-to-myocardium count on the prognosis of myocardium infarction

目的：探讨９９ｍＴｃ－ＭＩＢＩ静息心肌断层显像左室腔与心肌计数比值（Ｃ／Ｍ比值）对心肌梗塞（ＭＩ）患者预后的预测价值。方法：７４例行静息心肌显像的心肌梗塞患者按Ｃ／Ｍ比值分为Ｃ／Ｍ比值减低组和正常组，并对其进行随访，随访时间平均为２３月。未发生心脏事件者随访时间≥１２月。心脏事件包括：心源性死亡、非致死性心肌梗塞，心肌显像３月后的血运重建术（ＣＡＢＧ或ＰＴＣＡ）。结果：７４例心肌梗塞患者中Ｃ／Ｍ比值减低４１例，Ｃ／Ｍ比值正常３３例，随访期间发生心脏事件分别为１８例（４３．９％），５例（１５．２％），Ｃ／Ｍ比值减低的ＭＩ患者心脏事件发生率显著高于Ｃ／Ｍ比值正常者（Ｐ＜０．０１）。Ｌｏｇ－ｒａｎｋ统计分析两组未发生心脏事件率差异有显著性（Ｐ＜０．０５）。Ｃｏｘ多元回归显示，Ｃ／Ｍ比值减低是发生心脏事件独立的影响因素（ＲＲ＝５． ３８，９５％的可信限ＣＩ １． ８６～１６．１３，Ｐ＜０． ０１）。结论：９９ｍＴｃ－ＭＩＢＩ静息心肌断层显像 Ｃ／Ｍ比值对ＭＩ患者的预后判断有较重要的价值，Ｃ／Ｍ比值减低是估测心肌梗塞患者不良预后的独立指标。

Objective: To evaluate the prognostic value of left ventricular cavity - to - myocardium count ratio(C/M ratio) on 99m Tc - MIBI myocardial perfusion imaging for patients with myocardial infarction (MI) in the resting state. Methods: Seventy-four pa- tients with MI who underwent 99m To -MIBI myocardial perfusion tomography in the resting state were divided into decreased C/M ra- tio group and normal C/M ratio group. They were followed up for 23 months(range 4-36 months) and even longer than 12 months for patients with no cardiac events(CE). Death due to primary cardiac cause, or nonfatal myocardial reinfarction and CABG or PTCA oc- curring>3 months after resting state myocardial perfusion imaging were considered CE. Results: Of the 74 MI patients, forty-one pa- tients had decreased C/M ratio and 33 had normal C/M ratio. During the folow - up period, there were 23 CE in 41 decreased C/M ratio patients and five in 33 normal C/M ratio patients. There were significance difference between decreased C/M ratio patients and normal C/M ratio patients group (X2 = 7. 06, P<0 01). Patients with decreased C/M ratio had a significantly lower no - CE rates than those with normal C/M ratio patients(X2 = 4. 14, P<0. 05, Log- rank test). With multivariate Cox regression analysis, decreased C/ M ratio was an independent predictor Of CE(RR = 5. 38, 95% confidence interval[CI] 1. 86 - 16. 13, P<0. 01 ). Conclusion: In pa- tients with MI, C/M ratio on resting state myocardial perfusion imaging gives useful information in the evaluation of prognosis, de- creased C/M ratio is an important independent predictor of a bad prognosis.