心肌灌注显像正常的冠心病患者预后的研究

Prognosis of patients with coronary heart disease and normal myocardial perfusion imaging

目的:观察不同危险因素对心肌灌注显像提示灌注正常的冠心病患者预后的影响。方法:选择心肌灌注显像正常的冠心病患者99例,均于静息及负荷状态下行门控心肌静息显像测定左心室功能参数,所有患者均行电话随访直到自然死亡(死于其他病因)或者发生致死性或非致死性心脏事件,或者45个月实验终止,采用Cox比例风险回归模型分析致死性和非致死性心脏事件的危险因素。结果:随访45个月期间,死亡15例,年平均全因死亡率为5.05%,9例(9.09%)患者发生致死性心脏事件,21例(21.21%)发生非致死性心脏事件。Cox比例风险回归分析显示,吸烟及左室射血分数<50%是预测发生致死性心脏事件的危险因素(HR=4.887、3.365,P=0.043,0.002)。而糖尿病、血脂异常、吸烟及左室射血分数<50%被认为是非致死性心脏事件的危险因素(HR=2.215~4.544,P均<0.05)。结论:心肌核素显像结果提示正常的冠心病患者仍有较高的心血管事件发生率。有吸烟及心功能受损的心肌灌注显像正常冠心病患者预后不良。

Objective： To observe influence of different risk factors on prognosis of patients with coronary heart disease （CHD） and normal myocardial perfusion imaging outcome. Methods： A total of 99 CHD patients with normal myocardial perfusion imaging outcome were selected. Left ventricular function indexes were measured by gated resting myocardial imaging in resting and stress state. All patients received telephone follow-up until natural death （died of other causes） or fatal or non-fatal heart attacks, or the termination of the experiment after 45 months. Cox proportion risk regression model was used to analyze risk factors of fatal and non-fatal heart attacks. Results.. A total of 15 cases died during the 45-month follow-up. Mean all-cause mortality per year was 5.05%. Fatal heart attacks occurred in nine cases （9.09%）, and non-fatal heart attacks occurred in 21 cases （21.21%）. Cox proportion risk regression analysis indicated that smoking and left ventricular ejection fraction （LVEF） （50% were risk factors for fatal heart attacks （HR = 4. 887, 3. 365, P = 0. 043, 0. 002）, while diabetes mellitus, dyslipidemia, smoking and LVEF〈50% were risk factors for non-fatal heart attacks （HR = 2. 215-4. 544, P〈0.05 all）. Conclusion： Incidence rate of cardiovascular events is higher in CHD patients with normal myocardial perfusion imaging. Smoking and impaired heart function suggest poor prognosis in these patients.