Focal severe decrease in myocardial technetium-99 m sestamibi uptake indicates ventricular irreversibility in patients with dilated cardiomyopathy
Focal severe decrease in myocardial technetium-99 m sestamibi uptake indicates ventricular irreversibility in patients with dilated cardiomyopathy
复制标题
心肌锝-99 m 司他米比摄取的局部严重减少表明扩张型心肌病患者的心室不可逆性
DOI：
10.1007/s12149-021-01625-4
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发表时间：
2021
影响因子：
2.6
通讯作者：
Sakata Yasushi
中科院分区：
文献类型：
--
作者：
Chimura Misato;Ohtani Tomohito;Sera Fusako;Nakamoto Kei;Konishi Shozo;Miyawaki Hiroshi;Kajitani Kenji;Higuchi Rie;Kioka Hidetaka;Hikoso Shungo;Tomiyama Noriyuki;Sakata Yasushi
目的Technetium-99 m sestamibi (99mTc-MIBI) 闪烁扫描可以识别无活力的左心室 (LV) 心肌。然而，扩张型心肌病(DCM) 患者无活性左心室心肌99mTc-MIBI 摄取减少的最佳临界值和细节尚未明确。本研究旨在评估每个节段和整个左心室心肌中 99mTc-MIBI 摄取的减少情况，并确定识别 DCM 患者中无活性左心室心肌的临界值。 方法 总体而言，53 例 LV 射血分数降低 (LVEF ≤ 40%) 的 DCM 患者接受了 99mTc-MIBI 闪烁扫描和心力衰竭的任何优化 治疗进行了评估。根据随访时 LVEF 绝对增加 ≥ 10% 单位导致 LVEF > 40% 的情况，将 LV 心肌分为存活或非存活。使用由不同阈值或标准参考确定的三个指数来评估 17 个节段中每个节段的心肌 99mTc-MIBI 摄取的减少：节段摄取百分比、休息评分和缺损程度。通过最小摄取百分比来评估整个左心室心肌的变化，并使用 17 个节段的汇总数据获得总静息评分 (SRS) 和左心室缺损程度。结果节段评估显示 18 名存活左心室心肌患者的 99mTc-MIBI 摄取轻度下降，而在无存活左心室患者中观察到局灶性严重摄取下降 心肌。在接受者操作特征曲线分析中，预测无活力左心室的最小摄取百分比、SRS和左心室缺损程度的截止值分别为39%（p< 0.01，曲线下面积[AUC]：0.87）、10（p< 0.01，AUC：0.91）和23%（p< 0.01，AUC： 0.92），分别。结论在 DCM 患者中， 心肌99mTc-MIBI%摄取<<40%表明心肌无活力。大约四分之一以上的左心室心肌的摄取的局部和严重减少可能表明左心室无活力。
ObjectiveTechnetium-99 m sestamibi (99mTc-MIBI) scintigraphy can identify non-viable left ventricular (LV) myocardium. However, the optimal cut-off value and the details of decreased99mTc-MIBI uptake of the non-viable LV myocardium in patients with dilated cardiomyopathy (DCM) have not been well established. This study aimed to evaluate the decrease in99mTc-MIBI uptake in each segment and in the whole LV myocardium, and to determine cut-off values for identifying non-viable LV myocardium in DCM patients.MethodsOverall, 53 DCM patients with reduced LV ejection fraction (LVEF ≤ 40%) who underwent99mTc-MIBI scintigraphy and any optimization of heart failure treatments were evaluated. LV myocardium was classified as viable or non-viable based on the absolute increase in LVEF of ≥ 10% unit leading to an LVEF of > 40% at follow-up, respectively. The decrease in myocardial99mTc-MIBI uptake in each of the 17 segments was evaluated using three indices determined by different thresholds or standard references: segmental %uptake, rest score, and defect extent. Changes in the whole LV myocardium were evaluated by the minimum %uptake, and the summed rest score (SRS) and extent of LV defect were obtained using summed data of 17 segments.ResultsSegmental evaluation indicated a mild decrease in99mTc-MIBI uptake in 18 patients with viable LV myocardium, whereas focal severe decrease in uptake was observed in patients with non-viable LV myocardium. In the receiver-operating characteristic curve analysis, the cut-off values of minimum %uptake, SRS, and LV defect extent for predicting non-viable LV were 39% (p< 0.01, area under the curve [AUC]: 0.87), 10 (p< 0.01, AUC: 0.91), and 23% (p< 0.01, AUC: 0.92), respectively.ConclusionsIn DCM patients, myocardial99mTc-MIBI %uptake of < 40% indicated non-viable myocardium. The focal and severe decrease in uptake in approximately more than a quarter of the LV myocardium may indicate non-viable LV.