Incremental Prognostic Value of Gated Rb-82 Positron Emission Tomography Myocardial Perfusion Imaging Over Clinical Variables and Rest LVEF
Incremental Prognostic Value of Gated Rb-82 Positron Emission Tomography Myocardial Perfusion Imaging Over Clinical Variables and Rest LVEF
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DOI：
10.1016/j.jcmg.2009.04.009
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发表时间：
2009-07-01
影响因子：
14
通讯作者：
Di Carli, Marcelo F.
中科院分区：
文献类型：
--
作者：
Dorbala, Sharmila;Hachamovitch, Rory;Di Carli, Marcelo F.
目的 本研究旨在研究门控铷 (Rb)-82 正电子发射断层扫描 (PET) 心肌灌注成像 (MPI) 相对于临床变量的增量价值，以预测生存和未来心脏事件。 背景 Rb-82 PET-MPI 和左心室射血分数 (LVEF) 储备（压力减去静息 LVEF）的预后价值尚不明确。 方法 1,432 名连续接受治疗的患者门控休息/血管舒张应激铷-82 PET 随访至少 1 年。其中，985 名患者获得了静息和峰值压力 LVEF 以及 LVEF 储备。评估了心脏事件 (CE)，包括心源性死亡或非致命性心肌梗塞和全因死亡。 结果 在平均 1.7 +/- 0.7 年的随访中，观察到 83 例 (5.8%) CE 和 140 例 (9.7%) 全因死亡。随着异常和缺血心肌百分比的增加，两个终点的风险均增加。在正常、轻度、中度或重度缺血扫描中，观察到的 CE 年化率分别为 0.7%、5.5%、5% 和 11%，全因死亡率分别为 3.3%、7.2%、6.9% 和 12.5%。在 985 名具有峰值压力门控数据的患者中，与 LVEF 储备 >= 0% 的患者相比，观察到 LVEF 储备 < 0% 的患者的 CE 年化率（2.1% vs. 5.3%，p < 0.001）和全因死亡率（4.3% vs. 9.2%，p < 0.001）较高。在 Cox 比例风险分析中，考虑临床、历史和静息 LVEF 信息后，应激 PET 结果和 LVEF 储备对于 CE 和全因死亡产生增量预后价值。 结论 血管扩张剂应激 Rb-82 PET-MPI 为历史/临床变量和静息 LVEF 提供增量预后价值，以预测无 CE 和全因死亡的生存。 PET-MPI 缺血百分比的增加与 CE 和全因死亡风险的增加相关。左心室射血分数储备为 Rb-82 MPI 预测未来不良事件的风险提供了显着的独立和增量价值。 （J Am Coll Cardiol Img 2009；2：846-54）(C) 2009 年，美国心脏病学会基金会
OBJECTIVES This investigation sought to study the incremental value of gated rubidium (Rb)-82 positron emission tomography (PET) myocardial perfusion imaging (MPI) over clinical variables for predicting survival and future cardiac events.BACKGROUND The prognostic value of Rb-82 PET-MPI and left ventricular ejection fraction (LVEF) reserve (stress minus rest LVEF) is not well defined.METHODS 1,432 consecutive patients undergoing gated rest/vasodilator stress rubidium-82 PET were followed up for at least 1 year. Of these, rest and peak stress LVEF and LVEF reserve were available in 985 patients. Cardiac events (CE) including cardiac death or nonfatal myocardial infarction and all-cause death were assessed.RESULTS Over a mean follow-up of 1.7 +/- 0.7 years, 83 (5.8%) CE and 140 (9.7%) all-cause death were observed. There was an increase in risk for both end points with an increasing percentage of abnormal and ischemic myocardium. With normal, mild, moderate, or severely ischemic scans, the observed annualized rates of CE were 0.7%, 5.5%, 5%, and 11% and of all-cause death were 3.3%, 7.2%, 6.9%, and 12.5%, respectively. In 985 patients with peak stress gated data, the observed annualized rates of CE (2.1% vs. 5.3%, p < 0.001) and all-cause death (4.3% vs. 9.2%, p < 0.001) were higher in patients with an LVEF reserve < 0% compared with those with an LVEF reserve >= 0%. On Cox proportional hazards analysis, after consideration of clinical, historical, and rest LVEF information, stress PET results and LVEF reserve yielded incremental prognostic value with respect to both CE and all-cause death.CONCLUSIONS Vasodilator stress Rb-82 PET-MPI provides incremental prognostic value to historical/clinical variables and rest LVEF to predict survival free of CE and all-cause death. An increasing percentage of ischemia on PET-MPI is associated with an increase in the risk of CE and all-cause death. Left ventricular ejection fraction reserve provides significant independent and incremental value to Rb-82 MPI for predicting the risk of future adverse events. (J Am Coll Cardiol Img 2009; 2: 846-54) (C) 2009 by the American College of Cardiology Foundation