高龄患者三磷酸腺苷负荷心肌灌注断层显像的远期预后价值

目的 评价三磷酸腺苷(ATP)负荷~(99m)Tc-甲氧基异丁基异腈(MIBI)心肌灌注断层显像对高龄患者(≥80岁)的远期预后价值.方法 对265例行ATP负荷~(99m)Tc-MIBI心肌灌注断层显像的患者(84.2±3.6)岁,随访(36.7±22.8)个月.观察心脏事件心源性死亡、非致死性心肌梗死(MI)、不稳定性心绞痛、心力衰竭住院及经皮冠状动脉介入治疗术]和恶性心脏事件(心源性死亡和非致死性MI).结果 根据心肌灌注显像将患者分为固定或混合性缺损组、可逆性减低及缺损组、正常显像组,各组心脏事件发生率为50,0%、31.3%、6.2%(P<0.05),恶性心脏事件发生率分别为27.8%、6.0%、0.7%(P<0.05).Cox多元回归分析显示异常心肌灌注显像是预测高龄患者发生心脏事件和恶性心脏事件的独立危险因子(P<0.05).结论 ATP负荷~(99m)Tc-MIBI心肌灌注断层显像正常的高龄患者预后良好,心肌显像异常患者心脏事件和恶性心脏事件的发生率明显增加,存在固定或混合性缺损的患者预后更差,其检查对于高龄患者心脏事件风险的评估有较高的临床参考价值.

Prognostic value of adenosine tri phosphate myocardial perfusion tomography in octogenarians

Objective To evaluate the prognostic value of ~(99m)Tc-MIBI myocardial perfusion single-photon emission computed tomography (MPS) with adenosine triphosphate in patients aged 80 years or older. Methods A total of 265 patients mean age (84. 2 ±3.6) years old ] who underwent adenosine triphosphate and rest ~(99m)Tc-MIBI myocardial SPECT imaging were followed-up for (36. 7 ± 22. 8 ) months. Results During the period of follow-up, 57 patients (20. 4% ) suffered from cardiac events, including 20 major events: 5 cardiac death and 15 acule non-fatal myocardial infarction, 14 unstable angina pectoris,7 heart failure and 16 cases undergoing PCI. The cardiac event rate in patients with fixed or mixed perfusion defects (n = 54) was 50%, which was significantly higher lhan that in patients with reversible perfusion defects(n=67, 31. 3% ,P<0. 05) and normal perfusion imaging( n = 144, 6. 2% ,P <0. 01 ) . The major cardiac event rate in patients with fixed or mixed perfusion defects was 27. 8% , which was significantly higher than that in those with reversible perfusion defects ( 6. 0% , P < 0. 05) and normal perfusion imaging (0.7%, P < 0. 01 ) . Cox multivariate analysis revealed that an abnormal MPS was the most important independent predictor of major or total cardiac events. Conclusions ~(99m) Tc-MIBI MPS with ATP is demonstrated to be a powerful tool for the prognostic evaluation in octogenarian population. Octogenarians with a normal MPS have a low risk of major or total cardiac events, but when an abnormal MPS is present, the risk is significantly higher, being highest in patients with fixed or mixed perfusion defects.