用运动负荷^(99)Tc^m-MIBI SPECT心肌显像预测急性心肌梗死预后

Prognostic value of stress ^(99)Tc^m-MIBI myocardial perfusion SPECT after acute myocardial infarction

目的 探讨运动负荷99Tcm 甲氧基异丁基异腈 (MIBI)SPECT心肌断层显像判断急性心肌梗死 (AMI)患者预后的价值。方法 对 10 1例AMI患者出院前行运动负荷99Tcm MIBISPECT检查 ,随访心脏良性与不良事件的发生 ,分析心脏事件发生的相关因素及评估对心脏事件的预测价值。结果 多因素相关分析表明 ,AMI后心脏不良事件的独立预测因素是既往有心肌梗死病史 ,低运动积分和左室射血分数 (LVEF) <40 %。结论 AMI患者出院前行99Tcm MIBISPECT检查可获取运动能力、左室功能和心肌缺血状况等资料 ,从而鉴别高危患者 ,评估不良预后 。

Objective To investigate relativity of acute myocardial infarction (AMI) with clinical, stress test and perfusion imaging parameters and to assess predictive value on hard events of cardiac death or recurrent nonfatal AMI. Methods One hundred and one patients of AMI underwent stress 99Tc m-MIBI SPECT before discharge. Hard and soft events were followed-up, relative factors with cardiac events were analyzed by statistical methods and predictive value on hard events were assessed. Results Independent predictors by multivariate analysis for cardiac hard events or all cardiac events consisted of a history of prior AMI(RR=5.30,CI 2.17～12 98), a low exercise capacity (RR=6.28,CI 1.92～21.46)and left ventricular ejection fraction <40%(RR=2.93,CI 1.24～8.03). A history of diabetes mellitus also was independent predictor for all cardiac events. Conclusions Stress 99Tc m-MIBI SPECT is a single test that can provide exercise parameter, cardiac perfusion imaging information and left ventricular function assessment to identify high-risk and estimate hard prognosis at discharge of AMI patients. These high-risk patients can be referred for early invasive evaluation and intervention.