目的 评价运动负荷SPECT心肌灌注显像(myocardial perfusion single-photon emission computed tomography,MPS)对左心室射血分数(left ventricular ejection fractiton,LVEF)＞45％的怀疑心肌缺血患者主要心血管不良事件(major adverse cardiovascular events,MACEs)的预测作用.方法 连续入选2013年6月-2016年3月在首都医科大学附属北京友谊医院住院的怀疑心肌缺血患者,患者均完善2日法运动负荷99mTc-MIBI MPS,图像采用20节段5分制进行半定量分析,根据负荷心肌灌注总积分(summed stress score,SSS)将患者分为两组,SSS 0～7分组及SSS≥8分组.对患者在院外进行电话随访,观察MACEs发生情况.结果 共入选患者295例,SSS 0～7分组243例(男/女:133/110),SSS≥8分组共52例(男/女:40/12).SSS≥8分组与SSS 0～7分组相比,男性比例较高,典型心绞痛症状及陈旧性心肌梗死病史比例较高(P＜0.05),超声心动左心室舒张末内径及左心室收缩末内径较大、室壁运动异常比例较高(P均＜0.05),左心室射血分数相对较低(P=0.000).SSS 0 ～7分组发生MACEs共39例次(16.0％),SSS≥8分组组发生MACEs共13例次(25.0％),两组无统计学差异(P=0.124).两组心脏性死亡、非致死性心肌梗死、心绞痛住院及再血管化比例均无统计学差异.通过Kaplan-Meier曲线法对两组患者进行生存分析发现,SSS≥8分组累积生存率偏低(P=0.042),SSS 0～7分组年心脏事件发生率为1％,而SSS≥8分组为2％.结论 对于LVEF＞45％的患者,运动负荷SPECT心肌灌注显像能够较好地预测MACEs,而SSS≥8分提示心血管事件风险较高.%Objective To assess the predicting value of exercise stress 99m-technetium myocardial perfusion single-photon emission computed tomography (MPS,SPECT) for major adverse cardiovascular events (MACEs) in patients suspected of coronary artery disease (CAD) and LVEF ＞ 45％.Methods Patients who were suspected of CAD admitted to Beijing Friendship Hospital from June 2013 to March 2016 were enrolled in this study.All patients had undergone exercise 99mTc-sestamibi MPS for evaluation of ischemia,then were divided into two groups according to summed stress score (SSS):SSS 0-7 group and SSS ≥ 8 group.The patients were followed up by telephone to record the occurrence of MACEs.Results A total of 295 patients were enrolled,243 patients (male/female 133/110) were in SSS 0-7 group and 52 (male/female 40/12) were in SSS ≥ 8 group.Compared with SSS 0-7 score group,SSS ≥ 8 score group had higher proportion of males,typical symptoms of angina pectoris,history of myocardial infarction and abnormal wall motion (All P ＜ 0.05),greater echocardiographic left ventricular end diastolic diameter and left ventricular end systolic diameter (All P ＜ 0.05),and lower left ventricular ejection fraction (P=0.000).The incidence of MACEs in SSS 0-7 score group was 16％ (n=39),versus 25％ (n=13) in SSS ≥ 8 score group,with no significant difference (P=0.124).There was no statistically significant difference in the incidences of cardiac death,non-fatal myocardial rehospitalization infarction,rehospitalization for angina pectoris,and revascularization between the two groups.The cumulative survival rate was lower in SSS ≥ 8 group compared with SSS 0-7 group by Kaplan-Meier curve (P=0.042).The incidence of cardiac events (including cardiac death and non-fatal myocardial infarction) of SSS 0-7 group was 1％,which was 2％ in SSS ≥ 8 group.Conclusion Exercise myocardial perfusion imaging can be applied for evaluating cardiovascular risk of patients suspected of myocardial ischemia and LVEF ＞ 45％.MPI indicates that SSS ≥ 8 is an indication of revascularization therapy.
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