Incidence and predictors of heart failure during long-term follow-up after stress Tc-99m sestamibi tomography in patients with suspected coronary artery disease
Incidence and predictors of heart failure during long-term follow-up after stress Tc-99m sestamibi tomography in patients with suspected coronary artery disease
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DOI：
10.1016/j.nuclcard.2004.04.011
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发表时间：
2004-09-01
影响因子：
2.4
通讯作者：
Poldermans, D
中科院分区：
文献类型：
--
作者：
Elhendy, A;Schinkel, AFL;Poldermans, D
背景心力衰竭是冠状动脉疾病（CAD）患者发病和死亡的主要原因。本研究的目的是确定在长期随访期间，对可疑CAD患者进行负荷心肌灌注成像（stress myocardial perfusion imaging）的心力衰竭发生率和预测因素。我们研究了787例（平均年龄57 - 12岁，470名男子）与怀疑CAD谁没有以前的心肌梗死或心力衰竭的运动史（n = 508）或多巴酚丁胺（n = 279）应力锝99 mSestamibi单光子发射计算机断层扫描。随访患者心力衰竭、非致死性心肌梗死和死亡的发生情况。在341名患者（43%）中检测到异常灌注扫描（可逆或固定灌注缺损）。在平均6.7 ± 2.3年的随访中，46例患者（6%）发生心力衰竭，170例患者（22%）死亡，52例患者（7%）发生非致命性心肌梗死。发生心力衰竭的患者年龄较大，（平均年龄：60 ± 12岁vs 56 ± 12岁; P =.01），男性（34 [74%] vs 436 [59%]，P =.01）和扫描异常（32 [70%] vs 309 [42%]，P =.0002）的可能性高于无心力衰竭的患者。仅3例患者（7%）在心力衰竭发作前发生非致死性心肌梗死。多因素分析显示，心力衰竭的预测因素为年龄（危险比[RR]，1.04 [95%CI，1.01-1.08]）、男性（RR，2 [95%CI，1.3-4.5]）、静息心率（RR，1.1 [95%CI，1.05-1.2%]）和扫描异常（RR，2.3 [95%CI，1.4 -3.9]）。诊断为心力衰竭后的年死亡率为15%。在疑似CAD且无心肌梗死病史的患者中，晚期心力衰竭可通过年龄、性别、静息心率和灌注异常预测，并且与相当高的死亡率相关。大多数心力衰竭事件是由sestamibi单光子发射计算机断层扫描的灌注异常预示的，而不是由早期心肌梗死预示的。
Background. Heart failure is a major cause of morbidity and death in patients with coronary artery disease (CAD). The aim of this study was to define the incidence and predictors of heart failure during long-term follow-up in patients with suspected CAD referred for stress myocardial perfusion imaging.Methods and Results. We studied 787 patients (mean age, 57 12 years; 470 men) with suspected CAD who had no history of previous myocardial infarction or heart failure with exercise (n = 508) or dobutamine (n = 279) stress technetium 99m sestamibi single photon emission computed tomography. Patients were followed up for the occurrence of heart failure, nonfatal myocardial infarction, and death. An abnormal perfusion scan (reversible or fixed perfusion defect) was detected in 341 patients (43%). During a mean follow-up of 6.7 +/- 2.3 years, heart failure occurred in 46 patients (6%), 170 patients (22 %) died, and 52 patients (7 %) had nonfatal myocardial infarction. Patients in whom heart failure developed were older (mean age, 60 +/- 12 years vs 56 12 years; P =.01) and were more likely to be men (34 [74 %] vs 436 [59 %], P =.01) and to have an abnormal scan (32 [70%] vs 309 [42%], P =.0002) compared with patients without heart failure. Nonfatal myocardial infarction occurred before the onset of heart failure in only 3 patients (7%). By multivariate analysis, predictors of heart failure were age (risk ratio [RR], 1.04 [95 % CI, 1.01-1.08]), male gender (RR, 2 [95 % CI, 1.3-4.5]), resting heart rate (RR, 1.1 [95 % CI, 1.05-1.2% and abnormal scan (RR, 2.3 [95% CI,1.4-3.9]). The annual mortality rate was 15% after the diagnosis of heart failure.Conclusion. In patients with suspected CAD and no history of myocardial infarction, late heart failure is predicted by age, gender, resting heart rate, and abnormal perfusion, and it is associated with a substantial mortality rate. The majority of heart failure events are heralded by perfusion abnormalities on sestamibi single photon emission computed tomography but not by an earlier myocardial infarction.