Prognostic value of I-123 metaiodobenzylguanidine imaging in vasospastic angina without significant coronary stenosis.
Prognostic value of I-123 metaiodobenzylguanidine imaging in vasospastic angina without significant coronary stenosis.
复制标题
I-123 间碘苄胍成像对无明显冠状动脉狭窄的血管痉挛性心绞痛的预后价值。
DOI：
10.1253/circj.69.171
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
O. Doi
中科院分区：
文献类型：
--
作者：
K. Sakata;K. Iida;M. Kudo;H. Yoshida;O. Doi
背景
心肌显像被广泛用于检测冠状动脉疾病和评估其预后。在血管痉挛型心绞痛(VA)中，心脏成像可以提供与心脏事件相关的疾病活动的信息。本研究旨在探讨Tl-201运动显像(TL-SPECT)和~(123)I-间碘苯甲基胍显像(MIBG)对无明显冠状动脉狭窄的VA患者的预后价值。
方法和结果
105例乙酰胆碱诱发冠脉痉挛，左心功能正常，无明显狭窄(50%)的患者在1个月内同时行症状受限的TL-SPECT和MIBG检查。所有患者在随访期间(平均4.7年)服用钙拮抗剂。运动诱发缺血53例，冠状动脉造影发现多支血管痉挛33例。随访期内，1例猝死，1例死于急性心肌梗死。2例发生非致命性急性心肌梗死，7例因不稳定型心绞痛急诊冠状动脉造影术。根据基线特征，有心脏事件的VA患者的心脏-纵隔比(H/M)显著高于无心脏事件患者(分别为0.03和0.02)，MIBG洗脱率显著低于无心脏事件患者(P<；0.03和P<；0.02)。在冠脉危险因素、运动参数、运动缺血率、MIBG延迟H/M比值和洗脱率8个临床变量中，单因素Cox比例风险回归分析显示，高H/M比值和MIBG洗脱率降低是预测未来心脏事件的显著因素(相对危险度(RR)=4，可信区间(CI)=1.21~13.29，p<；0.02对H/M比和RR 0.92，CI 0.85~0.99，p<；0.02对洗脱率)。然而，运动性缺血并未表现出任何统计学意义。多变量Cox比例风险回归分析显示，MIBG洗脱率降低是未来心脏事件的唯一有意义的预测因素(优势比=0.90，CI=0.82-1.00，p<；0.04)。
结论
MIBG成像可以识别高危患者，即使是那些以前被认为是低风险的VA患者。这一结果有力地支持了心脏交感神经功能障碍导致冠状动脉痉挛导致心脏事件的观点。
BACKGROUND
Myocardial imaging is widely used to detect coronary artery disease and to assess its prognosis. In vasospastic angina (VA), cardiac imaging can provide information on disease activity, which is related to cardiac events. The aim of this study was to clarify whether exercise thallium-201 imaging (Tl-SPECT) and 123I-metaiodobenzylguanidine imaging (MIBG) have prognostic value for patients with VA, but without significant coronary artery stenosis.
METHODS AND RESULTS
One hundred and 5 patients who showed acetylcholine-induced coronary spasm, normal left ventricular function and no significant stenosis (<50%) underwent both symptom-limited Tl-SPECT and MIBG within 1 month. All patients were prescribed calcium antagonist during the follow-up period (mean 4.7 years). Exercise-induced ischemia was detected by Tl-SPECT in 53 patients and multivessel coronary spasm by coronary angiography in 33 patients. During the follow-up period, 1 patient died suddenly and another died of acute myocardial infarction (MI). Two patients developed nonfatal acute MI and 7 patients underwent emergency coronary angiography because of unstable angina. According to the baseline characteristics, VA with cardiac events showed a significantly higher heart-to-mediastinum ratio (H/M ratio) and a significantly lower MIBG washout rate than those without cardiac events (p<0.03 and p<0.02, respectively). Among 8 clinical variables, including coronary risk factors, exercise parameters and exercise-induced ischemia on Tl-SPECT and the MIBG delayed H/M ratio and washout rate, univariate Cox proportional hazard regression analysis showed that the high H/M ratio and reduced washout rate of MIBG were significant predictors of future cardiac events (relative risk (RR) =4, confidence interval (CI) =1.21-13.29, p<0.02 for H/M ratio and RR 0.92, CI 0.85-0.99, p<0.02 for washout rate). However, exercise-induced ischemia did not show any statistical significance. By multivariate Cox proportional hazard regression analysis, a reduced MIBG washout rate was the only significant predictor of future cardiac events (odds ratio =0.90, CI =0.82-1.00, p<0.04).
CONCLUSION
MIBG imaging can identify high-risk patients, even among those with VA who were previously regarded as low risk. This result strongly supports the idea that cardiac sympathetic dysfunction contributes to coronary artery spasm leading to cardiac events.