Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction
Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction
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DOI：
10.1007/s12350-021-02874-6
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发表时间：
2021-12-16
影响因子：
2.4
通讯作者：
Sciagra, R.
中科院分区：
文献类型：
--
作者：
Calabretta, R.;Castello, A.;Sciagra, R.
目的。在门控心肌灌注 SPECT 中，心尖重塑可通过左心室 (LV) 的发散模式 (DP) 的存在来识别。方法和结果。我们检查了 150 名前壁 ST 段抬高型心肌梗死 (STEMI) 患者，所有患者均通过直接经皮冠状动脉介入治疗 (PCI) 获得成功治疗。出院前采集灌注门控 SPECT 测量梗死面积、左心室舒张末期 (ED) 和收缩末期 (ES) 容积以及射血分数 (EF)，并在 6 个月随访时重复测量。 26 名患者中观察到 DP，与无 DP 的患者相比，梗死面积较大（28 +/- 19% vs. 15.7 +/- 17%，P < 0.02），EF 较低（33 +/- 7% vs. 41 +/- 10%，P < 0.001）。随访时，DP患者的EDV显着增大（156 +/- 54 vs. 107 +/- 44 mL，P < 0.0001），ESV（104 +/- 47 vs. 59 +/- 36 mL，P < 0.0001）和较低的EF（35 +/- 12% vs. 48 +/- 13%，P < 0.0001）。 54% 的 DP 患者在随访时出现重塑，而无 DP 患者的这一比例为 12% (P < 0.001)。随访期间，DP 组发生 7 起事件（27%），无 DP 患者发生 11 起事件（9%；P < 0.02）。 Kaplan-Meier 生存曲线显示 DP 患者的预后较差。结论。在前部 AMI 患者中，早期 DP 检测与随后的左心室功能障碍、梗塞面积更大和严重程度更差有关。它有助于预测短期随访中的左室重塑，并具有预后意义。
Purpose. In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).Methods and Results. We examined 150 anterior ST-elevation myocardial infarction (STEMI) patients, all successfully treated with primary percutaneous coronary interventions (PCI). Perfusion gated-SPECT to measure infarct size, LV end-diastolic (ED) and end-systolic (ES) volumes and ejection fraction (EF) was acquired before hospital discharge and repeated at 6-month follow-up. DP was observed in 26 patients, who had larger infarct size (28 +/- 19% vs. 15.7 +/- 17%, P < 0.02), and lower EF (33 +/- 7% vs. 41 +/- 10%, P < 0.001) than patients without DP. At follow-up, DP patients had significantly larger EDV (156 +/- 54 vs. 107 +/- 44 mL, P < 0.0001), ESV (104 +/- 47 vs. 59 +/- 36 mL, P < 0.0001) and lower EF (35 +/- 12% vs. 48 +/- 13%, P < 0.0001). 54% of DP patients developed remodeling at follow-up vs. 12% of those without DP (P < 0.001). During follow up, 7 events in the DP group (27%) and 11 events in patients without DP (9%; P < 0.02) occurred. Kaplan-Meier survival curves showed a worse prognosis for DP patients.Conclusion. In patients with anterior AMI, early DP detection is related to subsequent LV dysfunction, larger infarct size, and worse severity. It is helpful for predicting LV remodeling at short-term follow-up and has prognostic implications.