三磷酸腺苷负荷心肌灌注显像冠状动脉血流储备在老年冠心病患者中的预后研究

Study on coronary flow reserve in the prognosis of elderly patients with coronary heart disease with adenosine triphosphate loaded myocardial perfusion imaging

目的分析三磷酸腺苷(ATP)负荷心肌灌注显像(MPI)时冠状动脉血流储备(CFR)对老年冠心病患者发生主要不良心血管事件(MACE)的预测价值。方法回顾性分析2019年1月—2021年12月于复旦大学附属华东医院就诊的208例老年冠心病患者的临床资料。根据受试者有无发生MACE分为研究组(n=71)与对照组(n=137)。比较2组的年龄、性别、心肌梗死、心绞痛、高血压、糖尿病、吸烟、β受体阻滞剂使用情况、CFR和心肌缺血。二元logistic回归法分析老年冠心病患者发生MACE的影响因素,受试者操作特征(ROC)曲线分析CFR对老年冠心病患者预后的价值。结果与对照组相比,研究组心肌梗死、糖尿病和心肌缺血构成比较多,β受体阻滞剂使用者较少,CFR较低,差异均有统计学意义(P<0.05)。二元logistic回归显示,心肌梗死和CFR降低是老年冠心病患者发生MACE的危险因素,使用β受体阻滞剂是老年冠心病患者发生MACE的保护因素。ROC曲线显示,CFR临界值为2.10,曲线下面积为0.799,灵敏度为76.10%,特异度为27.00%,约登指数为0.491(P<0.05)。结论ATP负荷MPI时CFR降低对老年冠心病患者发生MACE可能具有预测价值。

Objective To analyze the predictive value of coronary flow reserve(CFR)in the occurrence of major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD)during adenosine triphosphate(ATP)loaded myocardial perfusion imaging(MPI).Methods A retrospective analysis was conducted on the clinical data of 208 elderly CHD patients admitted to Huadong Hospital Affiliated to Fudan University from January 2019 to December 2021.They were divided into study group(n=71)and control group(n=137)according to whether MACE occurred.The age,gender,myocardial infarction,angina pectoris,hypertension,diabetes,smoking,β-blocker use,CFR,and myocardial ischemia were compared between the two groups.The binary logistic regression method was used to analyze the influencing factors of MACE in elderly CHD patients,and the receiver operating characteristic(ROC)curve was used to analyze the value of CFR in predicting the prognosis of elderly CHD patients.Results Compared with the control group,the study group had higher constituent ratio of myocardial infarction,diabetes and myocardial ischemia,fewer users ofβ-blockers,and lower CFR,with statistical significance(P<0.05).Binary logistic regression showed that myocardial infarction and decreased CFR were risk factors for MACE in elderly CHD patients,andβ-blocker use was a protective factor for MACE in elderly CHD patients.The ROC curve showed that the critical value of CFR was 2.10,the area under the curve was 0.799,the sensitivity was 76.10%,the specificity was 27.00%,and the Yoden index was 0.491(P<0.05).Conclusion The decrease in CFR during ATP loaded MPI may have predictive value for the occurrence of MACE in elderly CHD patients.