| 孙茉茉,李剑明,刘志刚.冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像检测冬眠心肌的临床研究[J].中国医学影像技术,2018,34(7):1003~1008 |
| 冠状动脉旁路移植术前13N-NH3/18F-FDG PET显像检测冬眠心肌的临床研究 |
| Clinical study of 13N-NH3/18F-FDG PET in detecting hibernating myocardium before coronary artery bypass grafting |
| 投稿时间：2017-09-01 修订日期：2018-04-09 |
| DOI：10.13929/j.1003-3289.201709005 |
| 中文关键词: 正电子发射型体层摄影术 心肌灌注显像 代谢显像 冬眠 心肌 冠状动脉旁路移植术 |
| 英文关键词:Positron-emission tomography Myocardial perfusion imaging Metabolic imaging Hibernation Myocardium Coronary artery bypass |
| 基金项目:天津市卫生和计划生育委员会科技基金重点攻关项目（16KG145）、天津市滨海新区卫生和计划生育委员会科技项目（2015BWKL002）。 |
|
| 摘要点击次数: 2714 |
| 全文下载次数: 916 |
| 中文摘要: |
| 目的 探讨PET/CT检测冬眠心肌数量预测伴有心功能不全的冠状动脉粥样硬化性心脏病（以下简称冠心病）患者冠状动脉旁路移植术（CABG）后左心室射血分数（LVEF）改善的价值并寻找与心脏主要不良事件（MACE）相关的影响因素。方法 收集46例LVEF严重减低（≤ 40%）且接受CABG的冠心病患者，术前均接受超声心动图检查，且行13N-NH3/18F-FDG PET/CT心肌灌注-代谢显像评估冬眠心肌数量，于术后3~32个月复查超声心动图，评价LVEF情况，并追踪MACE发生情况。根据术后LVEF将患者分为LVEF改善组和LVEF未改善组，筛选两组有统计学差异的因素，并以二元Logistic回归分析术后LVEF改善的影响因素；采用ROC曲线确定预测CABG术后LVEF能否改善的冬眠心肌数量的界值；根据随访中发生MACE与否将患者分为两组，分析与MACE发生的相关因素。结果 与LVEF未改善组比较，术后LVEF改善组冬眠心肌数量较多，瘢痕心肌数量较少，患者术前左心室收缩末期容积（LVESV）较小，差异均有统计学意义（P均<0.05）；冬眠心肌数量及术前LVESV是CABG术后影响LVEF改善的独立因子；冬眠心肌预测LVEF改善的界值为21%；与MACE事件发生有关的因素为二尖瓣重度反流。结论 PET/CT检测冬眠心肌数量对预测伴心功能不全冠心病患者CABG后LVEF改善情况具有重要价值。 |
| 英文摘要: |
| Objective To explore the value of hibernating myocardium quantitatively detected with PET/CT in predicting improvement of left ventricular ejection fraction (LVEF) and to investigate impact factors related to major adverse events (MACE) after coronary artery bypass grafting (CABG) in patients with coronary heart disease (CHD).Methods Totally 46 CHD patients with severely reduced LVEF (≤ 40%) who received CABG were enrolled. All patients underwent echocardiography to assess cardiac function and 13N-ammonia (NH3)/18F-fluorodeoxyglucose (FDG) PET/CT to assess hibernating myocardium before CABG. Echocardiography was performed again 3-32 months after CABG to analyze the improvement of LVEF, and MACE was evaluated. Then the patients were divided into LVEF improved group and LVEF non-improved group. The factors which had statistical difference were screened in the two groups, and binary Logistic analysis was used to analyze the relationship between statistically different indexes and postoperative LVEF improvement. ROC curve was used to predict the amount of hibernating myocardium whose LVEF improved after CABG operation. The patients were further divided into two groups according to the occurrence of MACE, and the factors related to MACE were analyzed.Results LVEF improved group had more hibernating myocardium, less scar myocardium and smaller left ventricular end-systolic volume (LVESV) compared with LVEF non-improved group (all P<0.05). The number of hibernating myocardium and LVESV were the independent factors for predicting LVEF improvement. The optimal threshold value for the number of hibernating myocardium in predicting LVEF improvement was 21%. The factor associated with the occurrence of early MACE was severe mitral regurgitation.Conclusion The amount of hibernating myocardium assessed with PET/CT is an effective predictor of LVEF improvement after CABG in CHD patients. |
| 查看全文 查看/发表评论 下载PDF阅读器 |
