IR@PKUHSC  > 北京大学第五临床医学院
学科主题影像医学与核医学
门控心肌灌注显像左室舒张功能对不良心脏事件的预测价值
张娟
2016-05-12
导师姚稚明
专业影像医学与核医学
授予单位北京大学
授予地点北京大学第五临床医学院
学位硕士
关键词门控心肌灌注显像 左室舒张功能 不良心脏事件 预测价值
其他题名The predictive value for adverse cardiac events of left ventricular diastolic function measured by gated myocardial perfusion imaging
分类号R816.2
摘要

目的

门控心肌灌注显像(G-MPI)能“一站式”获取心脏左室心肌血流灌注、收缩与舒张功能及室壁运动等信息,是冠心病危险度分层及疗效评估的重要手段,本旨在探讨G-MPI测量的左室舒张功能对不良心脏事件(ACE)的预测价值。

    方法

随诊2012年3月至2013年5月在我科行两日法静息-负荷门控心肌灌注显像的158位患者,观察患者G-MPI后不良心脏事件发生率。不良心脏事件定义为心源性死亡、非致死性心肌梗死、晚期(G-MPI后60天以后)血运重建术(经皮冠状动脉介入治疗术及冠状动脉旁路移植术)。以QGS软件测量左室射血分数(LVEF)及左室高峰充盈率(PFR)等左室功能参数,按17节段划分左室心肌和5分评分法评定总负荷积分(SSS)。以Cox回归分析确定不良心脏事件的独立影响因素,Kaplan-Meier生存曲线分析累积无不良心脏事件生存率(ACER)。P<0.05被认为有统计学意义。

     结果

     排除早期(G-MPI后60天内)行血运重建术者11位(7.0%),最终入组139位患者, 累积发生不良心脏事件者9位(6.5%)。Cox回归分析显示SSS、LVEF、PFR(P<0.05)为预测ACE的独立影响因素。PFR<2.1组累积不良心脏事件发生率(14.3%)显著高于PFR≥2.1组(2.2%),P<0.01。以Kaplan—Meier

 

 

生存曲线分析比较各组累积无ACER显示:PFR<2.1组累积无ACER显著低于PFR≥2.1组、SSS≥8组累积无ACER显著低于SSS<8组、LVEF<50%组累积ACER显著低于LVEF≥50%组,均为P<0.01。以PFR分别联合LVEF及SSS行Kaplan—Meier生存曲线分析显示:PFR≥2.1时,LVEF≥50%组患者的累积无ACER与LVEF<50%组的无差异(P>0.05);PFR<2.1时,LVEF≥50%组患者的累积无ACER显著高于LVEF<50%组(P<0.01)。PFR≥2.1时,SSS<8组患者的累积无ACER明显高于SSS≥8组(P<0.01);PFR<2.1时,SSS<8组与SSS≥8组患者之间的累积无ACER无差异(P>0.05)。

    结论

    G-MPI测量的左室舒张功能参数—PFR是预测不良心脏事件的独立影响因素之一,联合PFR可以强化LVEF及SSS对不良心脏事件的预测价值。

英文摘要

 Objective

Gated myocardial perfusion imaging(G-MPI)is an important means of coronary artery disease risk stratification and curative effect evaluation .By this mean,we can acquire the patient’s left ventricular myocardial perfusion, systolic and diastolic function,and ventricular wall motion.In this paper ,we aim to study the predictive value for adverse cardiac events(ACE) of left ventricular diastolic function measured by gated myocardial imaging.

    Methods

Collecting 158 patients assessed by 2-day rest-stressed gated myocardial perfusion imaging during March, 2012 to May, 2013. Observing the patients’ incidence of adverse cardiac events after G - MPI. Adverse cardiac events including cardiac death, non-fatal myocardial infarction and late revascularization (60 days later after examination).Using QGS get the left ventricular ejection fraction(LVEF) ,left ventricular peak filling rate(PFR) and other left ventricular function diameters.Using 17 segments , 5- point scoring system to get the summed stress score(SSS). Independent predictors for adverse cardiac events were identified using Cox regression analysis. Cumulative incidence of no adverse cardiac events were investigated using the Kaplan–Meier method. All of the results were considered to have statistical value when P<0.05.

 

 

 

 

    Results

11(7.0%)patients who underwent early revascularization (within 60 days after examination) were excluded and 139 patients were assigned to different groups for outcome analysis. 9(6.5%) patients had ACE in the whole group. Cox regression analysis showed that SSS、LVEF、PFR(P<0.05)were the independent predictors for ACE. Patients with their PFR<2.1 had a higher incidence of ACE than patients with their PFR≥2.1(P<0.01). Kaplan Meier - survival analysis showed that patients with PFR<2.1 were more likely attacked by ACE than the one with PFR≥2.1 (P<0.01). Combining PFR with SSS and LVEF respectively, Kaplan Meier - survival analysis showed patients with SSS≥8 or LVEF<50% had a higher possibility to attacked by adverse cardiac events when PFR<2.1(P<0.01).

     Conclusion

 The parameter-PFR of left ventricular diastolic function measured by gated myocardial perfusion imaging is one of the independent predictors for ACE, and combining PFR with LVEF and SSS can effectively improve the predictive value for adverse cardiac events.

 Objective

Gated myocardial perfusion imaging(G-MPI)is an important means of coronary artery disease risk stratification and curative effect evaluation .By this mean,we can acquire the patient’s left ventricular myocardial perfusion, systolic and diastolic function,and ventricular wall motion.In this paper ,we aim to study the predictive value for adverse cardiac events(ACE) of left ventricular diastolic function measured by gated myocardial imaging.

    Methods

Collecting 158 patients assessed by 2-day rest-stressed gated myocardial perfusion imaging during March, 2012 to May, 2013. Observing the patients’ incidence of adverse cardiac events after G - MPI. Adverse cardiac events including cardiac death, non-fatal myocardial infarction and late revascularization (60 days later after examination).Using QGS get the left ventricular ejection fraction(LVEF) ,left ventricular peak filling rate(PFR) and other left ventricular function diameters.Using 17 segments , 5- point scoring system to get the summed stress score(SSS). Independent predictors for adverse cardiac events were identified using Cox regression analysis. Cumulative incidence of no adverse cardiac events were investigated using the Kaplan–Meier method. All of the results were considered to have statistical value when P<0.05.

 

 

 

 

    Results

11(7.0%)patients who underwent early revascularization (within 60 days after examination) were excluded and 139 patients were assigned to different groups for outcome analysis. 9(6.5%) patients had ACE in the whole group. Cox regression analysis showed that SSS、LVEF、PFR(P<0.05)were the independent predictors for ACE. Patients with their PFR<2.1 had a higher incidence of ACE than patients with their PFR≥2.1(P<0.01). Kaplan Meier - survival analysis showed that patients with PFR<2.1 were more likely attacked by ACE than the one with PFR≥2.1 (P<0.01). Combining PFR with SSS and LVEF respectively, Kaplan Meier - survival analysis showed patients with SSS≥8 or LVEF<50% had a higher possibility to attacked by adverse cardiac events when PFR<2.1(P<0.01).

     Conclusion

 The parameter-PFR of left ventricular diastolic function measured by gated myocardial perfusion imaging is one of the independent predictors for ACE, and combining PFR with LVEF and SSS can effectively improve the predictive value for adverse cardiac events.

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文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124786
专题北京大学第五临床医学院
作者单位北京大学第五临床医学院
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张娟. 门控心肌灌注显像左室舒张功能对不良心脏事件的预测价值[D]. 北京大学第五临床医学院. 北京大学,2016.
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