Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease
Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease
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DOI：
10.2967/jnumed.108.054395
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发表时间：
2009-02-01
影响因子：
9.3
通讯作者：
Slart, Riemer H. J. A.
中科院分区：
文献类型：
--
作者：
Tio, Rene A.;Dabeshlim, Ali;Slart, Riemer H. J. A.
本研究的目的是比较用 PET 评估的左心室射血分数 (LVEF) 和心肌灌注储备 (MPR) 对缺血性心脏病 (IHD) 患者的预后价值。心肌灌注是 IHD 患者左心室功能的主要决定因素。 LVEF 的预后价值已得到广泛确立。此外，MPR 决定肥厚型和扩张型心肌病患者的生存率。在本研究中，我们评估了 MPR 是否也决定了 IHD 患者的生存率。方法：1995 年至 2003 年间，连续 480 名慢性 IHD 患者接受双嘧达莫应激和静息 N-13-氨 PET 以确定 MPR。此外，还进行了 F-18-FDG PET 评估活力（不匹配缺陷）、梗死（匹配缺陷）和左心室功能。对患者的所有死亡原因和主要心血管事件进行随访。结果：在 480 名患者中，有 463 名患者能够测量到有效的 MPR（368 名男性；平均年龄，66 +/- 11 岁；LVEF，35% +/- 15%）。 119 名患者接受了 PET 驱动的血运重建（67 名患者通过经皮冠状动脉介入治疗，52 名患者通过冠状动脉旁路移植术）。其余 344 名患者是本研究的对象。总体 MPR 为 1.71 +/- 0.50（分位数边界，1.49 和 1.84）。调整年龄和性别后，MPR 与每 SD 降低 4.11 的心源性死亡风险比相关（95% 置信区间，2.98-5.67），而 LVEF 的风险为每 SD 降低 2.76（2.00-3.82）。结论：MPR 较低的 IHD 患者心源性死亡的风险较高。 MPR 是比 LVEF 更敏感的心源性死亡预测因子。
The purpose of this study was to compare the prognostic value of left ventricular ejection fraction (LVEF) and myocardial perfusion reserve (MPR) assessed with PET in patients with ischemic heart disease (IHD). Myocardial perfusion is the main determinant of left ventricular function in patients with IHD. The prognostic value of LVEF has been widely established. In addition, MPR determines survival in patients with hypertrophic and dilated cardiomyopathies. In the present study, we evaluated whether MPR also determines survival in patients with IHD. Methods: Between 1995 and 2003, 480 consecutive patients with chronic IHD underwent dipyridamole stress and rest N-13-ammonia PET to determine MPR. Additionally, F-18-FDG PET was performed for viability (mismatching defects), infarction (matching defects), and left ventricular function assessment. Patients were followed for all causes of mortality and major cardiovascular events. Results: In 463 of the 480 patients, valid MPR could be measured (368 men; mean age, 66 +/- 11 y; LVEF, 35% +/- 15%). One hundred nineteen patients underwent a PET-driven revascularization (67 through percutaneous coronary intervention and 52 through coronary artery bypass grafting). The remaining 344 patients were the subject of this study. The overall MPR was 1.71 +/- 0.50 (intertertile boundaries, 1.49 and 1.84). After adjustment for age and sex, MPR was associated with a hazard ratio for cardiac death of 4.11 (95% confidence interval, 2.98-5.67) per SD decrease, whereas the risk for LVEF was 2.76 (2.00-3.82) per SD decrease. Conclusion: Patients with IHD with a low MPR are at high risk of cardiac death. MPR is a more sensitive predictor for cardiac death than is LVEF.