门控SPECT心肌灌注显像相位分析评估左心室收缩同步性对室壁瘤患者长期预后的临床价值

摘要

目的:采用门控SPECT心肌灌注显像(GMPI)相位分析技术测定室壁瘤患者左心室机械收缩同步性,进一步评估其对室壁瘤患者长期预后的影响.方法:回顾性分析92例经心脏超声多普勒和/或心脏磁共振显像确诊的室壁瘤患者,其中男性78例,女性14例,年龄(57±10)岁,均行99mTc-MIBI静息门控SPECT心肌灌注显像,随访(57±16)个月.通过QGS软件获得左心室的功能参数,左心室舒张末期容积EDV (mL)、左心室收缩末期容积ESV (mL)、射血分数EF(％),通过相位分析获取左心室的机械收缩同步性参数,相位直方图带宽BW(°)、entropy(％)、相位标准差SD(°).心源性死亡和难治性心衰定义为恶性心脏事件.Kaplan-Meier方法获得生存曲线,Cox单因素及多因素回归分析获得预测恶性心脏事件的独立危险因子.结果:27(17％)例患者发生恶性心脏事件,恶性心脏事件患者左心室收缩同步性较无恶性心脏事件患者差[BW(130.4±54.9)vs.(95.0±51.1)°,r=-2.96,P=0.004),Entropy (67.6±11.3)vs(59.4±14.0)％,r=-2.93,P=0.005].Cox多因素分析附壁血栓形成和BW(HR=1.011,95％ CI:1.004～1.019,P=0.004)是预测恶性心脏事件的独立危险因子.室壁瘤患者左心室机械收缩不同步(BW≥90°或Entropy≥62％)时,无恶性心脏事件生存率(62.1％vs.85.3％,P=0.017)明显低于同步性好的患者.结论:相位分析技术所获取的室壁瘤患者左心室机械收缩同步性可以评估室壁瘤患者长期预后.左心室机械收缩同步性差的室壁瘤患者发生恶性心脏事件的风险更高.%Objective:The aim of this study was to investigate the prognostic value of left ventricular (LV) mechanical dyssynchrony (MD) assessed by gated SPECT myocardial perfusion imaging (GMPI) in patients with LV aneurysm (LVA).Methods:Ninety-two consecutive LVA patients determined by echocardiography and/or cardiac magnetic radiography imaging (CMR) (78 male,14 female,57 ± 10 years) who underwent 99mTc-MIBI GMPI at rest were followed-up for(57 ± 16)months.LV functional parameters were evaluated by QGS software,and EDV (mL),ESV (mL) and ejection fraction (EF,％) were obtained.Further,LV mechanical synchrony was analyzed by phase analysis,and parameters of BW (°),entropy (％) and SD (°)were obtained.LVMD were considered if BW ≥ 90° or Entropy ≥ 62％.During follow-up,cardiac death (CD) and intractable heart failure (HF) were defined as severe cardiac event,and served as the endpoint.Results:A total of 27 (17％) severe cardiac event were observed.Parameters of phase analysis in patients with severe cardiac event was significantly higher than that in patients without severe cardiac event,BW [(130.4-±54.9)°vs.(95.0-±51.1)°,r=-2.96,P=0.004],Entropy [(67.6±11.3)％ vs.(59.4± 14.0)％,r =-2.93,P =0.005].Multivariate Cox analysis revealed that lateral thrombus and BW (HR =1.011,95％CI:1.004-1.019,P =0.004) were independent predictor for severe cardiac event.Conclusion:LVA patients with LVMD determined by phase analysis of GMPI were at higher risk for severe cardiac event.