'False-positive' myocardial perfusion imaging: correlation with cardiovascular risk factors and effect on event-free survival
'False-positive' myocardial perfusion imaging: correlation with cardiovascular risk factors and effect on event-free survival
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DOI：
10.2459/jcm.0b013e3282f5ffc1
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发表时间：
2008-07-01
影响因子：
3
通讯作者：
Rovai, Daniele
中科院分区：
文献类型：
--
作者：
Gimelli, Alessia;Marzullo, Paolo;Rovai, Daniele
背景：在没有明显冠状动脉狭窄的情况下，门控单光子发射计算机断层扫描（g-SPECT）的应激性心肌灌注异常通常被认为是“假阳性”结果。我们的目的是研究假阳性的g-SPECT灌注异常与心血管危险因素的关系，以及它们是否提供任何预后信息。方法选择1999 ~ 2005年冠心病冠状动脉造影正常或管腔缩小小于50%、左室射血分数大于0.45的心绞痛患者130例。采用总差评分（SIDS）量化应激后心肌灌注异常程度。结果采用logistic回归模型，发现心血管危险因素（糖尿病、动脉高血压、吸烟习惯、高胆固醇血症和肥胖）与SDS密切相关（r= 0.96）。在44 +/- 7个月的随访中，6名患者发生了非致命性心脏事件。使用Cox比例风险回归分析，SDS大于7 （P < 0.0001）和糖尿病（P < 0.0001）是无事件生存的唯一独立预测因素。结论在无明显冠状动脉狭窄的心绞痛样胸痛患者中，g-SPECT应激性心肌灌注异常与心血管危险因素相关，是随访期间少数轻微心脏不良事件的独立预测因素。
Background In the absence of significant coronary stenoses, stress-induced myocardial perfusion abnormalities at gated single photon emission computed tomography (g-SPECT) are usually considered to be a 'false-positive' result. Our goal was to investigate how false-positive g-SPECT perfusion abnormalities relate to cardiovascular risk factors and whether they provide any prognostic information.Methods From 1999 to 2005, a group of 130 anginal patients with myocardial perfusion abnormalities at stress g-SPECT, with normal coronary angiography or less than 50% lumen reduction and with a left ventricular ejection fraction more than 0.45, was selected. The extent of myocardial perfusion abnormalities after stress was quantified using the summed difference score (SIDS).Results Using a logistic regression model, it was found that cardiovascular risk factors (diabetes mellitus, arterial hypertension, smoking habit, hypercholesterolemia and obesity) were closely related (r= 0.96) to the SDS. During a 44 +/- 7-month follow-up, six patients experienced nonfatal cardiac events. An SDS more than 7 (P < 0.0001) and diabetes mellitus (P < 0.0001) were the only independent predictors of event-free survival using Cox proportional hazard regression analysis.Conclusion In patients with anginal-like chest pain and without significant coronary stenoses, stress-induced myocardial perfusion abnormalities at g-SPECT correlate with cardiovascular risk factors and are independent predictors of the few, minor adverse cardiac events during the follow-up.