门控心肌灌注显像对家族性高胆固醇血症患者全因死亡风险的预测价值

Predictive value of gated myocardial perfusion imaging for all-cause mortality risk in patients with familial hypercholesterolemia

目的评估负荷+静息门控心肌灌注显像(G-MPI)对家族性高胆固醇血症(FH)患者全因死亡风险的预测价值。方法对2010年6月至2022年3月于首都医科大学附属北京安贞医院经临床和基因诊断确诊FH并行负荷+静息G-MPI检查的72例患者[男39例、女33例,年龄(21.1±12.3)岁]进行回顾性随访。图像分析采用17节段5分法,获得左心室心肌血流灌注及功能参数。随访患者全因死亡事件,采用Cox回归分析与全因死亡风险有关的预测因子。通过ROC曲线分析预测因子的效能,采用Kaplan-Meier法和log-rank检验比较不同组FH患者全因死亡发生率的差异。采用两独立样本t检验或Mann-Whitney U检验分析数据。结果72例FH患者的随访时间为7(4,10)年,随访期间共16例(22.2%)患者发生全因死亡。死亡组与存活组间的总胆固醇(TC)、低密度脂蛋白胆固醇(LDLC)、负荷灌注总积分(SSS)、静息灌注总积分(SRS)、总积分差值(SDS)、负荷左心室收缩末期容积(SESV)、负荷左心室射血分数(SEF)、静息左心室舒张末期容积(REDV)、静息左心室收缩末期容积(RESV)、静息左心室射血分数(REF)差异均有统计学意义(t值:-2.65~4.47,z值:-3.43~-1.98,均P<0.05)。Cox回归分析显示SDS[风险比(HR)=1.337,95%CI:1.114~1.604,P=0.002]、SESV(HR=1.019,95%CI:1.008~1.030,P<0.001)、LDLC(HR=1.355,95%CI:1.049~1.749,P=0.020)是FH患者全因死亡风险相关的独立预测因子。通过ROC曲线分析确定预测FH患者死亡的SESV最佳界值为35.5 ml,AUC为0.701(95%CI:0.517~0.885),SESV≥35.5 ml组全因死亡发生率明显高于SESV<35.5 ml组(28.6%和6.9%;χ^(2)=5.15,P=0.023)。结论负荷+静息G-MPI是对FH患者进行全因死亡风险评估的重要影像学手段,SDS、SESV、LDLC是预测FH患者发生死亡的重要因素。

Objective To evaluate the predictive value of stress+rest gated myocardial perfusion imaging(G-MPI)in assessing all-cause mortality risk in patients with familial hypercholesterolemia(FH).Methods From June 2010 to March 2022,72 patients(39 males,33 females;age(21.1±12.3)years)who diagnosed with FH clinically and genetically and underwent stress+rest G-MPI in Beijing Anzhen Hospital,Capital Medical University were retrospectively followed up.Image analysis was performed using the 17-segment 5-point method to obtain left ventricular myocardial perfusion and functional parameters.Patients were followed for all-cause mortality events,and predictors associated with the risk of all-cause mortality were analyzed using Cox regression.The efficiencies of predictors were evaluated by ROC curve analysis,and the Kaplan-Meier method and log-rank test were used to compare the differences in the incidence of all-cause mortality in different groups of patients with FH.Independent-sample t test or Mann-Whitney U test was used to analyze the data.Results The follow-up time of 72 patients was 7(4,10)years,and all-cause death occurred in 16(22.2%)patients during the follow-up period.There were statistically significant differences in total cholesterol(TC),low density lipoprotein cholesterol(LDLC),summed stress score(SSS),summed rest score(SRS),summed difference score(SDS),stress end-systolic volume(SESV),stress ejection fraction(SEF),rest end-diastolic volume(REDV),rest end-systolic volume(RESV)and rest ejection fraction(REF)between the death group and the survival group(t values:from-2.65 to 4.47,z values:from-3.43 to-1.98,all P<0.05).Cox regression analysis showed that SDS(hazard ratio(HR)=1.337,95%CI:1.114-1.604,P=0.002),SESV(HR=1.019,95%CI:1.008-1.030,P<0.001)and LDLC(HR=1.355,95%CI:1.049-1.749,P=0.020)were independent predictors associated with the risk of all-cause mortality in patients with FH.The optimal cut-off value of SESV for predicting mortality in patients with FH determined by ROC curve analysis was 35.5 ml,with the AUC of 0.701(95%CI:0.517-0.885).The incidence of all-cause mortality in the group with SESV≥35.5 ml was significantly higher than that in the group with SESV<35.5 ml(28.6%vs 6.9%;χ^(2)=5.15,P=0.023).Conclusion Stress+rest G-MPI is an important imaging method for all-cause mortality risk assessment in patients with FH,and SDS,SESV and LDLC are important factors in predicting mortality in patients with FH.