Objective To evaluate the prognostic value of peak ejection rate (PER) and peak filling rate (PFR) in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infraction (AMI).Methods A total of 123 patients (103 males,20 females,age:(60.6± 11.2) years) with LVSD after AMI who underwent 99Tc-methoxyisobutylisonitnle (MIBI) gated SPECT myocardial perfusion imaging (GSMPI) from January 2014 to December 2015 were retrospectively analyzed.Summed rest score (SRS) and total perfusion deficit (TPD) were acquired by using quantitative perfusion SPECT (QPS) soft-ware.Left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),PER,and PFR were calculated by using quantitative gated SPECT (QGS) software.The clinical parameters of patients were recorded and the cardiac events were taken as the endpoint of follow-up (median time:27 (range:9-50) months).Pearson correlation was used to analyze the correlation between PER and PFR.Receiver operating characteristic (ROC) curve was used to evaluate optimal cut-off values of PER and PFR for predicting cardiac events.Kaplan-Meier survival analysis and Cox proportional hazards model were also used for data analysis.Results There was a great correlation between PER and PFR (r =-0.931,P＜0.001).Optimal cut-off values of PER and PFR for predicting cardiac events were-1.10 EDV/s and 1.09 EDV/s respectively.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients (n=48) with-PER≤ 1.10 EDV/s than that in patients (n=75) with-PER＞ 1.10 EDV/s (16.7％ vs 66.7％;x2=60.096,P＜0.001),and the same rate in patients (n=50) with PFR ≤ 1.09 EDV/s was lower than that in patients (n=73) with PFR＞1.09 EDV/s (16.0％ vs 68.5％;x2=74.771,P＜0.001).Cox multivariate analysis showed that PER (hazard ratio (HR)=0.40,95％ CI:0.20-0.83) and PFR (HR=0.22,95％ CI:0.12-0.47) were independent predictors for cardiac events.Conclusion There is a great correlation between PER and PFR in patients with LVSD after AMI and they are independent predictors for cardiac events.%目的 探讨高峰射血率(PER)及高峰充盈率(PFR)预测急性心肌梗死(AMI)后左心室收缩功能不全(LVSD)患者预后的临床价值.方法 回顾性分析2014年1月至2015年12月在AMI血运重建术后出现LVSD的123例患者[男103例、女20例,年龄(60.6±11.2)岁].患者均行99Tcm-甲氧基异丁基异腈(MIBI)门控心肌灌注断层显像(GSMPI).通过定量灌注SPECT(QPS)软件分析心肌灌注图像,获得总静息评分(SRS)和总灌注缺损面积(TPD);通过定量门控SPECT (QGS)软件分析左心室功能参数,包括左心室射血分数(LVEF)、舒张末期容积(EDV)、收缩末期容积(ESV)、PER及PFR.收集一般临床资料并随访患者[中位随访时间27(范围:9～50)个月],以发生心血管事件为随访终点.对PER和PFR进行Pearson相关分析,通过受试者工作特征(ROC)曲线获得预测心血管事件发生的PER及PFR最佳阈值,并采用Kaplan-Meier生存曲线和Cox回归模型对患者进行分析.结果 PER和PFR两者之间高度相关(r=-0.931,P＜0.001),两者预测心血管事件发生的最佳阈值分别为-1.10和1.09 EDV/s.Kaplan-Meier生存分析示-PER≤1.10 EDV/s组(48例)无心血管事件发生生存率较-PER＞ 1.10 EDV/s(75例)明显减低(16.7％与66.7％;x2=60.096,P＜0.001);PFR≤1.09 EDV/s组(50例)无心血管事件发生生存率较PFR＞ 1.09 EDV/s(73例)明显减低(16.0％与68.5％;x2=74.771,P＜0.001).Cox多因素分析示PER[风险比(HR)=0.40,95％ CI:0.20～0.83)及PFR(HR=0.22,95％ CI:0.12～0.47)是影响本组患者发生心血管事件的独立预后因素.结论 AMI血运重建术后LVSD患者PER及PFR高度相关,且对心血管事件的发生有独立预测价值.
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