Myocardial perfusion pattern for stratification of ischemic mitral regurgitation response to percutaneous coronary intervention.
Myocardial perfusion pattern for stratification of ischemic mitral regurgitation response to percutaneous coronary intervention.
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DOI：
10.1097/mca.0000000000000271
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发表时间：
2015-12
影响因子：
1.8
通讯作者：
Weinsaft JW
中科院分区：
文献类型：
--
作者：
Goyal P;Kim J;Feher A;Ma CL;Gurevich S;Veal DR;Szulc M;Wong FJ;Ratcliffe MB;Levine RA;Devereux RB;Weinsaft JW
缺血性二尖瓣返流（MR）是常见的，但其对经皮冠状动脉介入治疗（PCI）的反应知之甚少。本研究测试了心肌灌注成像（MPI）对PCI的MR反应分层的效用。对行PCI的患者进行MPI和超声心动图检查。MPI用于评估负荷/静息心肌灌注。通过超声心动图评估二尖瓣返流（PCI前后进行）。317例MPI显示心肌灌注异常的患者在PCI前25±39天接受了超声心动图检查。52%存在二尖瓣返流，其中24%为晚期（≥中度）二尖瓣返流。二尖瓣返流与MPI和超声心动图上的左室腔扩张相关（均p<0.001）。左室整体灌注缺损的程度与二尖瓣返流的严重程度相关（p<0.01）。灌注差异最大的是总体静息评分总和，晚期MR患者的静息评分是轻度MR患者的1.6倍（p=0.004），是无MR患者的2.4倍（p<0.001）。在多变量分析中，晚期MR与MPI上的固定灌注缺损大小相关（OR 1.16/节段[CI 1.002-1.34]，p=0.046），与LV体积无关（OR 1.10/10 ml [CI 1.04-1.17]，p=0.002）。超声随访（1.0±0.6年）显示31%的患者二尖瓣返流降低（≥1级），12%的患者二尖瓣返流增加。PCI后MR增加的患者在基线MPI上有更严重的下壁灌注缺损（p=0.028），而其他分布和LV体积的缺损相似（p=NS）。SPECT证实的心肌灌注缺损的程度和分布影响MR对血运重建的反应。下壁固定灌注缺损程度增加可预测PCI术后MR进展。
Ischemic mitral regurgitation (MR) is common, but its response to percutaneous coronary intervention (PCI) is poorly understood. This study tested utility of myocardial perfusion imaging (MPI) for stratification of MR response to PCI. MPI and echo were performed among patients undergoing PCI. MPI was used to assess stress/rest myocardial perfusion. MR was assessed via echo (performed pre- and post-PCI). 317 patients with abnormal myocardial perfusion on MPI underwent echo 25±39 days prior to PCI. MR was present in 52%, among whom 24% had advanced (≥moderate) MR. MR was associated with LV chamber dilation on MPI and echo (both p<0.001). Magnitude of global LV perfusion deficits increased in relation to MR severity (p<0.01). Perfusion differences were greatest for global summed rest scores, which were 1.6-fold higher among patients with advanced MR vs. those with mild MR (p=0.004), and 2.4-fold higher vs. those without MR (p<0.001). In multivariate analysis, advanced MR was associated with fixed perfusion defect size on MPI (OR 1.16 per segment [CI 1.002–1.34], p=0.046) independent of LV volume (OR 1.10 per 10ml [CI 1.04–1.17], p=0.002). Follow-up via echo (1.0±0.6 years) demonstrated MR to decrease (≥1 grade) in 31% of patients, and increase in 12%. Patients with increased MR after PCI had more severe inferior perfusion defects on baseline MPI (p=0.028), whereas defects in other distributions and LV volumes were similar (p=NS). Extent and distribution of SPECT-evidenced myocardial perfusion defects impacts MR response to revascularization. Increased magnitude of inferior fixed perfusion defects predicts post-PCI progression of MR.