Prognostic Value of PET Myocardial Perfusion Imaging in Obese Patients
Prognostic Value of PET Myocardial Perfusion Imaging in Obese Patients
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DOI：
10.1016/j.jcmg.2013.12.008
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发表时间：
2014-03-01
影响因子：
14
通讯作者：
Beanlands, Rob S.
中科院分区：
文献类型：
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作者：
Chow, Benjamin J. W.;Dorbala, Sharmila;Beanlands, Rob S.
本研究旨在确定和比较正电子发射断层扫描（PET）在正常、超重和肥胖患者中的预后和增量价值。背景心脏铷82（Rb-82）PET越来越多地用于心肌灌注成像（MPI）。PET的优势在于其精确的衰减校正，从而潜在地提高其在肥胖患者中的诊断准确性。PET在肥胖患者中的预后价值尚未得到很好的研究。方法：共7,061例接受Rb-82 PET MPI的患者进入一个多中心观察注册。所有患者均接受药物Rb-82 PET检查，并随访心源性死亡和全因死亡率。根据体重指数（BMI），患者被归类为正常（≥ 30 kg/m2）。使用17节段模型和5分评分系统，计算应激和静息患者的异常心肌百分比，分为正常（0%）、轻度（0%）和轻度（0%）。（0.1%至9.9%），中度结果：共随访了6,037例心源性死亡患者（中位数：2.2岁），平均BMI为30.5 +/- 7.4 kg/m（2）。共观察到169例心源性死亡。PET MPI显示出相对于BMI的独立和增量预后价值。正常PET MPI预后良好，正常（0.38%）、超重（0.43%）和肥胖（0.15%）患者的年心源性死亡率非常低。同样，PET MPI正常的中度和重度肥胖患者预后良好（分别为0.20%和0.10%）。PET的净重新分类改进为0.46（95%可信区间[CI]：0.31 - 0.61），中度和重度肥胖患者的差异相似，均为0.44（95%CI：0.12 ~ 0.76）和0.63（95%CI：0.27 ~ 0.98）。在肥胖人群中，其他方式可能会降低诊断准确性，心脏PET似乎是一个有前途的非侵入性方式与预后价值。(C)2014年美国心脏病学会基金会
OBJECTIVES This study sought to determine and compare the prognostic and incremental value of positron emission tomography (PET) in normal, overweight, and obese patients.BACKGROUND Cardiac rubidium82 (Rb-82) PET is increasingly being used formyocardial perfusion imaging (MPI). A strength of PET is its accurate attenuation correction, thereby potentially improving its diagnostic accuracy in obese patients. The prognostic value of PET in obese patients has not been well studied.METHODS A total of 7,061 patients who had undergone Rb-82 PET MPI were entered into a multicenter observational registry. All patients underwent pharmacologic Rb-82 PET and were followed for cardiac death and all-cause mortality. Based on body mass index (BMI), patients were categorized as normal (= 30 kg/m(2)). Using a 17-segment model and 5-point scoring system, the percentage of abnormal myocardium was calculated for stress and rest patients categorized as normal (0%), mild (0.1% to 9.9%), moderate (10% to 19.9%), and severe (>= 20%).RESULTS A total of 6,037 patients were followed for cardiac death (median: 2.2 years) and the mean BMI was 30.5 +/- 7.4 kg/m(2). A total of 169 cardiac deaths were observed. PET MPI demonstrated independent and incremental prognostic value over BMI. Normal PET MPI conferred an excellent prognosis with very low annual cardiac death rates in normal (0.38%), overweight (0.43%), and obese (0.15%) patients. As well, both moderately and severe obese patients with a normal PET MPI had excellent prognosis (0.20% and 0.10%, respectively). The net reclassification improvement of PET was 0.46 (95% confidence interval [CI]: 0.31 to 0.61), and appeared similar in the moderately and severe obese patients which were 0.44 (95% CI: 0.12 to 0.76) and 0.63 (95% CI: 0.27 to 0.98), respectively.CONCLUSIONS Rb-82 PET has incremental prognostic value in all patients irrespective of BMI. In the obese population, where other modalities may have reduced diagnostic accuracy, cardiac PET appears to be a promising noninvasive modality with prognostic value. (C) 2014 by the American College of Cardiology Foundation