门控心肌灌注显像左室舒张功能对不良心脏事件的预测价值

Predictive value for adverse cardiac events of left ventricular diastolic function measured by gated myocardial perfusion imaging

目的 探讨G-MPI测量的左室舒张功能对不良心脏事件（ACE）的预测价值.方法 随诊2012年3月至2013年5月在北京医院核医学科行两日法静息-负荷G-MPI的患者,观察G-MPI后累积无ACE生存率.ACE包括心源性死亡、非致死性MI、晚期（G-MPI后60 d）血运重建术.以门控心肌断层显像（QGS）软件测量LVEF及左室高峰充盈率（PFR）,按17节段划分左室心肌,以5分评分法评定总负荷积分（SSS）.以Cox回归分析确定ACE的独立影响因素,Kaplan-Meier生存曲线分析累积无ACE生存率.采用χ2检验分析数据.结果 排除早期（G-MPI后60 d内）行血运重建术者11例,最终入组139例患者（男76例,女63岁;平均68.73岁）,累积发生ACE 9例（6.5%,9/139）.Cox回归分析显示SSS、LVEF、PFR为预测ACE的独立影响因素（均P＜0.05）.PFR＜2.1 EDV/s组ACE发生率明显高于PFR≥2.1 EDV/s组[14.3%（7/49）和2.2%（2/90）,χ2=7.63,P＜0.05].Kaplan-Meier生存曲线显示,对于累积无ACE生存率,PFR＜2.1 EDV/s组明显低于PFR≥2.1 EDV/s组（67.7%与95.0%）,LVEF＜50%组明显低于LVEF≥50%组（32.0%与90.8%）,SSS≥8组明显低于SSS＜8组（62.0%与94.7%;χ2 值：11.92、11.27和10.40,均P＜0.01）;以PFR分别联合LVEF及SSS行Kaplan-Meier生存曲线分析显示：对于累积无ACE生存率,PFR＜2.1 EDV/s时,LVEF≥50%组明显高于LVEF＜50%组（76.7%与30.8%;χ2=7.14,P＜0.01）;PFR≥2.1 EDV/s时,SSS＜8组患者明显高于SSS≥8组（100%与72.2%;χ2=13.09,P＜0.01）.结论 PFR是预测ACE的独立影响因素之一,联合PFR可强化LVEF及SSS对ACE的预测价值.

Objective To study the predictive value for adverse cardiac events （ACE） of left ventricular diastolic function measured by G-MPI. Methods Patients assessed by 2 days rest-stressed G-MPI during March 2012 to May 2013 in Beijing Hospital were collected and observed for the cumulative survival rate without ACE after G-MPI. ACE included cardiac death, non-fatal MI and late revascularization （60 d after the examination）. Using quantitative gated SPECT （QGS） to get the LVEF and left ventricular peak filling rate （PFR）. Using 17 segments, 5-point scoring system to get the summed stress score （SSS）. Cox regression analysis was used to identify the independent predictors for ACE, and Kaplan-Meier method was used to investigate the cumulative survival rate without ACE. χ2 test was also used. Results A total of 11 patients who underwent early revascularization （within 60 d after G-MPI） were excluded and 139 patients （76 males, 63 females; average age 68.73 years） were assigned to different groups for outcome analysis, and 9 （6.5%, 9/139） patients had ACE in the whole group. Cox regression analysis showed that SSS, LVEF, PFR were the independent predictors for ACE （all P〈0.05）. Patients with PFR〈2.1 EDV/s had a higher incidence of ACE than those with PFR≥2.1 EDV/s （14.3%（7/49） vs 2.2%（2/90）, χ2=7.63, P〈0.05）. Kaplan-Meier survival analysis showed that the cumulative survival rate without ACE was lower in patients with PFR〈2.1 EDV/s than that in patients with PFR≥2.1 EDV/s （67.7% vs 95.0%）, and lower in patients with LVEF〈50% than that in patients with LVEF≥50%（32.0% vs 90.8%）, and also lower in patients with SSS≥8 than those with SSS〈8（62.0% vs 94.7%; χ2 values： 11.92,11.27, 10.40, all P〈0.01）. Combining PFR with SSS and LVEF respectively, Kaplan-Meier survival analysis showed that the cumulative survival rate without ACE in patients with LVEF≥50% was higher than that in patients with LVEF〈50% when PFR〈2.1 EDV/s （76.7% vs 30.8%）, and also higher in patients with SSS〈8 than that in patients with SSS≥8 when PFR≥2.1 EDV/s （100% vs 72.2%; χ2 values： 7.14, 13.09, both P〈0.01）. Conclusion PFR of left ventricular diastolic function measured by G-MPI is one of the independent predictors for ACE, and it could effectively improve the predictive value for ACE if combined with LVEF and SSS.