Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography
Prognostic value of cardiac hybrid imaging integrating single-photon emission computed tomography with coronary computed tomography angiography
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DOI：
10.1093/eurheartj/ehr047
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发表时间：
2011-06-01
影响因子：
39.3
通讯作者：
Kaufmann, Philipp A.
中科院分区：
文献类型：
--
作者：
Pazhenkottil, Aju P.;Nkoulou, Rene N.;Kaufmann, Philipp A.
目的虽然心脏混合成像融合了单光子发射计算机断层扫描(SPECT)心肌灌注成像和冠状动脉计算机断层血管成像(CCTA)，为冠状动脉疾病(CAD)评估提供了重要的补充诊断信息，但目前尚无心脏混合成像预测价值的数据。因此，本研究的目的是评估SPECT/CCTA混合成像的预后价值。方法和结果连续335例患者接受了为期1天的负荷/静息~99m-Tetrofosmin SPECT和CCTA，通过独立扫描仪获取并融合获得心脏混合成像，324例患者获得了97%的随访率。无全因死亡或非致命性心肌梗死(MI)和无主要心脏不良事件(MACE：死亡、MI、需要住院的不稳定心绞痛、冠状动脉再血管化)的存活率采用Kaplan-Meier方法为以下组确定：(I)CCTA狭窄和匹配的可逆性SPECT缺损组；(Ii)CCTA和SPECT发现不匹配的组；(Iii)CCTA和SPECT发现正常的组。考克斯比例风险回归被用来确定心脏事件的独立预测因素。中位随访时间为2.8年(第25-75百分位数：1.9-3.6)，47例患者发生69次MACE，其中20例死亡/心肌梗死。相应的匹配混合影像发现与显著更高的死亡/心肌梗死发生率相关(P<；0.005)，并被证明是MACE的独立预测因素。在匹配、不匹配和正常的患者中，年死亡率/心肌梗死发生率分别为6.0、2.8和1.3%。结论心脏混合成像可以对已知或可疑冠心病患者进行风险分层。混合图像上的匹配缺陷是MACE的强烈预测因子。
Aims Although cardiac hybrid imaging, fusing single-photon emission computed tomography (SPECT) myocardial perfusion imaging with coronary computed tomography angiography (CCTA), provides important complementary diagnostic information for coronary artery disease (CAD) assessment, no prognostic data exist on the predictive value of cardiac hybrid imaging. Hence, the aim of this study was to assess the prognostic value of hybrid SPECT/CCTA images.Methods and results Of 335 consecutive patients undergoing a 1-day stress/rest Tc-99m-tetrofosmin SPECT and a CCTA, acquired on stand-alone scanners and fused to obtain cardiac hybrid images, follow-up was obtained in 324 patients (97%). Survival free of all-cause death or non-fatal myocardial infarction (MI) and free of major adverse cardiac events (MACE: death, MI, unstable angina requiring hospitalization, coronary revascularizations) was determined using the Kaplan-Meier method for the following groups: (i) stenosis by CCTA and matching reversible SPECT defect; (ii) unmatched CCTA and SPECT finding; and (iii) normal finding by CCTA and SPECT. Cox's proportional hazard regression was used to identify independent predictors for cardiac events. At a median follow-up of 2.8 years (25th-75th percentile: 1.9-3.6), 69 MACE occurred in 47 patients, including 20 death/MI. A corresponding matched hybrid image finding was associated with a significantly higher death/MI incidence (P < 0.005) and proved to be an independent predictor for MACE. The annual death/MI rate was 6.0, 2.8, and 1.3% for patients with matched, unmatched, and normal findings.Conclusion Cardiac hybrid imaging allows risk stratification in patients with known or suspected CAD. A matched defect on hybrid image is a strong predictor of MACE.