Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in ...Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in patients with HCM who are older. This study examined the prognostic significance of stress MPI in an adult population of patients with HCM. Methods: We examined 158 patients with HCM(aged 60± 16 years, 61% men) who underwent exercise or pharmacologic stress MPI. Summed stress score(SSS, normal=56) and summed reversibility scores were calculated for each patient. Follow- up was complete in 157(99% ) patients at a median duration of 5.2 years. Results: Normal single- photon emission computed tomography(SPECT) images were present in 38% of the population. Summed stress score(P=.01) and summed reversibility score(P=.03) were both significantly associated with cardiovascular death. Survival at 10 years was significantly better in those with normal versus abnormal SPECT(89% vs 67% , P= .04). Ten- year survival also was better in those without versus those with ischemia(90% vs 64% , P=.02). Five- year survival could be stratified by SSS risk categories: low risk(SSS ≥ 53), 97% ; intermediate risk(SSS=48- 52), 94% ; and high risk(SSS ≤ 47), 79% (P=.04). Bivariate models of SSS and other significant covariates supported an independent relation of SSS to cardiovascular death. Conclusions: In an older population of patients with HCM referred for SPECT imaging, abnormal stress MPI identifies those at increased risk of cardiovascular death.展开更多
背景单光子发射计算机断层显像(SPECT)已被广泛用于准确评估左心室收缩功能,但是,很少有研究将SPECT左心室舒张功能参数与已建立的左心室舒张功能参考标准进行比较。目的以左心导管检查的左心室舒张末压(LVEDP)为金标准,探讨SPECT评估...背景单光子发射计算机断层显像(SPECT)已被广泛用于准确评估左心室收缩功能,但是,很少有研究将SPECT左心室舒张功能参数与已建立的左心室舒张功能参考标准进行比较。目的以左心导管检查的左心室舒张末压(LVEDP)为金标准,探讨SPECT评估冠心病患者左心室舒张功能的敏感指标。方法前瞻性选择2021年9月至2022年1月于徐州医科大学附属医院心内科就诊,因可疑或已知冠心病行冠状动脉造影(CAG)检查并同时行左心导管检查的患者97例。患者均在入院后1~3 d完成超声心动图、SPECT检查,后行CAG检查及左心导管检查发现心外膜下冠状动脉直径狭窄超过50%确诊为冠心病。CAG检查及左心导管检查得到LVEDP、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)及左心室射血分数(LVEF)。SPECT检查得到心功能参数:LVESV'、LVEDV'、LVEF'、高峰充盈率(PFR)、前1/3充盈分数(1/3FF)、前1/3充盈率(1/3FR)、平均充盈率(MFR)、高峰充盈时间(TPF)。根据LVEDP测量结果,将患者分为左心室舒张功能正常组(LVEDP<16 mm Hg,50例)和左心室舒张功能不全组(LVEDP≥16 mm Hg,47例)。比较两组患者一般资料、实验室指标以及左心功能指标差异。分析SPECT参数与LVEDP间的相关性。应用受试者工作特征(ROC)曲线评价SPECT参数对LVEDP增高的预测价值。结果左心室舒张功能不全组LVEF'、PFR、1/3FF、1/3FR、MFR低于左心室舒张功能正常组,TPF高于左心室舒张功能正常组(P<0.05)。相关性分析结果显示,LVESV'与LVESV、LVEDV'与LVEDV、LVEF'与LVEF之间均呈正相关(r_(s)=0.726,P<0.001;r_(s)=0.651,P<0.001;r=0.450,P<0.001);PFR、1/3FF、1/3FR、MFR与LVEDP均呈负相关(r_(s)=-0.481、r_(s)=-0.212、r=-0.354、r_(s)=-0.305,P<0.05);TPF与LVEDP呈正相关(r=0.442,P<0.001)。PFR、1/3FF、1/3FR、MFR、TPF评价LVEDP增高的ROC曲线下面积(AUC)分别为0.778、0.662、0.653、0.663和0.755,灵敏度分别为60%、75%、57%、62%、77%,特异度分别为84%、62%、78%、68%、70%。结论对于LVEF≥50%的冠心病患者,SPECT左心室舒张功能参数可以识别LVEDP增高,在这些参数中,PFR和TPF有较好的可行性和更高的准确性。展开更多
文摘Background: Data derived from stress myocardial perfusion imaging(MPI) carry prognostic significance in young patients with hypertrophic cardiomyopathy(HCM), but there are limited data on the utility of stress MPI in patients with HCM who are older. This study examined the prognostic significance of stress MPI in an adult population of patients with HCM. Methods: We examined 158 patients with HCM(aged 60± 16 years, 61% men) who underwent exercise or pharmacologic stress MPI. Summed stress score(SSS, normal=56) and summed reversibility scores were calculated for each patient. Follow- up was complete in 157(99% ) patients at a median duration of 5.2 years. Results: Normal single- photon emission computed tomography(SPECT) images were present in 38% of the population. Summed stress score(P=.01) and summed reversibility score(P=.03) were both significantly associated with cardiovascular death. Survival at 10 years was significantly better in those with normal versus abnormal SPECT(89% vs 67% , P= .04). Ten- year survival also was better in those without versus those with ischemia(90% vs 64% , P=.02). Five- year survival could be stratified by SSS risk categories: low risk(SSS ≥ 53), 97% ; intermediate risk(SSS=48- 52), 94% ; and high risk(SSS ≤ 47), 79% (P=.04). Bivariate models of SSS and other significant covariates supported an independent relation of SSS to cardiovascular death. Conclusions: In an older population of patients with HCM referred for SPECT imaging, abnormal stress MPI identifies those at increased risk of cardiovascular death.
文摘背景单光子发射计算机断层显像(SPECT)已被广泛用于准确评估左心室收缩功能,但是,很少有研究将SPECT左心室舒张功能参数与已建立的左心室舒张功能参考标准进行比较。目的以左心导管检查的左心室舒张末压(LVEDP)为金标准,探讨SPECT评估冠心病患者左心室舒张功能的敏感指标。方法前瞻性选择2021年9月至2022年1月于徐州医科大学附属医院心内科就诊,因可疑或已知冠心病行冠状动脉造影(CAG)检查并同时行左心导管检查的患者97例。患者均在入院后1~3 d完成超声心动图、SPECT检查,后行CAG检查及左心导管检查发现心外膜下冠状动脉直径狭窄超过50%确诊为冠心病。CAG检查及左心导管检查得到LVEDP、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)及左心室射血分数(LVEF)。SPECT检查得到心功能参数:LVESV'、LVEDV'、LVEF'、高峰充盈率(PFR)、前1/3充盈分数(1/3FF)、前1/3充盈率(1/3FR)、平均充盈率(MFR)、高峰充盈时间(TPF)。根据LVEDP测量结果,将患者分为左心室舒张功能正常组(LVEDP<16 mm Hg,50例)和左心室舒张功能不全组(LVEDP≥16 mm Hg,47例)。比较两组患者一般资料、实验室指标以及左心功能指标差异。分析SPECT参数与LVEDP间的相关性。应用受试者工作特征(ROC)曲线评价SPECT参数对LVEDP增高的预测价值。结果左心室舒张功能不全组LVEF'、PFR、1/3FF、1/3FR、MFR低于左心室舒张功能正常组,TPF高于左心室舒张功能正常组(P<0.05)。相关性分析结果显示,LVESV'与LVESV、LVEDV'与LVEDV、LVEF'与LVEF之间均呈正相关(r_(s)=0.726,P<0.001;r_(s)=0.651,P<0.001;r=0.450,P<0.001);PFR、1/3FF、1/3FR、MFR与LVEDP均呈负相关(r_(s)=-0.481、r_(s)=-0.212、r=-0.354、r_(s)=-0.305,P<0.05);TPF与LVEDP呈正相关(r=0.442,P<0.001)。PFR、1/3FF、1/3FR、MFR、TPF评价LVEDP增高的ROC曲线下面积(AUC)分别为0.778、0.662、0.653、0.663和0.755,灵敏度分别为60%、75%、57%、62%、77%,特异度分别为84%、62%、78%、68%、70%。结论对于LVEF≥50%的冠心病患者,SPECT左心室舒张功能参数可以识别LVEDP增高,在这些参数中,PFR和TPF有较好的可行性和更高的准确性。
