99mTc-MIBI SPECT负荷心肌灌注显像对怀疑心肌缺血糖尿病患者的预后价值

Prognostic value of stress myocardial perfusion imaging with 99mTc-MIBI SPECT for diabetic patients with suspected myocardial ischemia

摘要:

目的 评价^99m锝-甲氧基异丁基异腈(^99mTc-MIBI)SPECT负荷心肌灌注显像(MPI)对怀疑心肌缺血的糖尿病患者主要不良心血管事件(MACEs)是否具有预测作用。方法 回顾性分析2013年6月至2016年3月首都医科大学附属北京友谊医院因怀疑心肌缺血而行 ^99mTc-MIBI SPECT负荷MPI的糖尿病住院患者165例,根据负荷总积分(SSS)值分为0～7分组和≥8分组,比较两组患者的生存和MACEs发生情况。采用SPSS 17.0软件进行数据分析。根据数据类型分别采用t检验、秩和检验或χ²检验比较组间差异。结果 两组患者男性比例、体质量指数(BMI)、左室射血分数(LVEF)、左室收缩末期内径(LVESD)、典型心绞痛、血运重建和室壁运动异常比例差异有统计学意义(P＜0.05)。两组间MACEs年发生率、因心绞痛住院率差异有统计学意义(P＜0.05)。Cox单因素回归分析结果表明室壁运动异常、SSS升高、冠心病家族史、既往血管重建治疗史、陈旧性心肌梗死史是MACEs的危险因素。Cox多因素回归分析结果表明冠心病家族史(RR＝2.964,5%CI 1.318~6.666；P=0.009)是MACEs的危险因素,其余变量无预测作用。Kaplan-Meier生存分析结果表明,SSS 0～7分组心脏事件年发生率为1%,SSS ≥8分组心脏事件年发生率为4%。相比SSS 0～7分组,SSS ≥8分组患者累积生存率偏低,差异有统计学意义(P=0.005)。结论 应用 ^99mTc-MIBI SPECT负荷MPI可对怀疑心肌缺血的糖尿病患者进行危险分层和预后评估,SSS ≥8分的糖尿病患者危险分层为高危,建议血管重建治疗。

Abstract:

Objective To investigate whether exercise stress myocardial perfusion imaging (MPI) with technetium-^99m-labelled methoxyisobutyl isonitrile single photon emission computed tomography (^99mTc-MIBI SPECT) has value in the prediction of major adverse cardiovascular events (MACEs) in the patients with type 2 diabetes mellitus who are suspected of myocardial ischemia. Methods A retrospective study was carried out on 165 diabetic patients who were suspected of myocardial ischemia and underwent ^99mTc-MIBI SPECT stress MPI in our department from June 2013 to March 2016. According to summed stress score (SSS), the patients were divided into SSS 0-7 group and SSS ≥8 group. The survival and incidence of MACEs were followed up after discharge by telephone. Clinical data were analyzed by SPSS statistics 17.0. The differences were compared with t test, rank-sum test or Chi-square test respectively. Results Significant differences were observed in proportion of males, body mass index (BMI), left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), typical angina, revascularization, wall motion abnormalities, incidence of MACEs and hospitalization rate due to angina between the 2 groups (P<0.05). Cox univariate regression analysis showed that ventricular wall motion abnormalities, increased SSS, family history of coronary heart disease, previous history of vascular remodeling, old myocardial infarction are risk factors for MACEs. Cox multivariate regression analysis indicated that the family history of coronary heart disease (RR=2.964,5%CI 1.318-6.666, P=0.009) was a risk factor for MACEs, and the other variables had no predictive effect. Kaplan-Meier survival analysis showed that the incidence of MACEs was 1% in the SSS 0-7 group and 4% in the SSS ≥8 group, with the cumulative survival rate higher in the former than the latter group (P=0.005). Conclusion ^99mTc-MIBI SPECT stress MPI can be used for risk stratification and prognosis assessment in the diabetic patients with suspected myocardialischemia. Vascular reconstruction can be recommended for those high-risk patients with SSS ≥8.