학술논문
[Predictive value of the proportion of hibernating myocardium in total perfusion defect on reverse remodeling in patients with HFrEF underwent coronary artery bypass graft].
Document Type
Academic Journal
Author
Lu Y; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Cao J; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Zhu EJ; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Gao MX; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Mou TT; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Zhang Y; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Xie XF; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Tian Y; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Yun MK; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Meng JJ; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Yang XB; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Lai YQ; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Dong R; Heart Surgery Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.; Zhang XL; Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Source
Publisher: Zhonghua yi xue hui Country of Publication: China NLM ID: 7910682 Publication Model: Print Cited Medium: Print ISSN: 0253-3758 (Print) Linking ISSN: 02533758 NLM ISO Abbreviation: Zhonghua Xin Xue Guan Bing Za Zhi Subsets: MEDLINE
Subject
Language
Chinese
ISSN
0253-3758
Abstract
Objective: To evaluate the predictive value of the proportion of hibernating myocardium (HM) in total perfusion defect (TPD) on reverse left ventricle remodeling (RR) after coronary artery bypass graft (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) by 99m Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with 18 F-flurodeoxyglucose (FDG) gated myocardial imaging positron emission computed tomography (PET). Methods: Inpatients diagnosed with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2016 to January 2022 were prospectively recruited. MPI combined with 18 F-FDG gated PET was performed before surgery for viability assessment and the patients received follow-up MPI and 18 F-FDG gated PET at different stages (3-12 months) after surgery. Δ indicated changes (post-pre). Left ventricular end-systolic volume (ESV) reduced at least 10% was defined as RR, patients were divided into reverse remodeling (RR+) group and the non-reverse group (RR-). Binary logistic regression analysis was used to identify predictors of RR. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to assess the cut-off value for predicting RR. Additionally, we retrospectively enrolled inpatients with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2021 to January 2022 as the validation group, who underwent MPI and 18 F-FDG gated PET before surgery. Echocardiography was performed before CABG and after CABG (3-12 months). In the validation group, the reliability of obtaining the cut-off value for the ROC curve was verified. Results: A total of 28 patients with HFrEF (26 males; age (56.9±8.7) years) were included in the prospective cohort. HM/TPD was significantly higher in the RR+ group than in the RR- group ((51.8%±17.9%) vs . (35.7%±13.9%), P =0.016). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of RR (Odds ratio=1.073, 95% Confidence interval: 1.005-1.145, P =0.035). ROC curve analysis revealed that HM/TPD=38.3% yielded the highest sensitivity, specificity, and accuracy (all 75%) for predicting RR and the AUC was 0.786 ( P =0.011). Meanwhile, a total of 100 patients with HFrEF (90 males; age (59.7±9.6) years) were included in the validation group. In the validation group, HM/TPD=38.3% predicted RR in HFrEF patients after CABG with the highest sensitivity, specificity and accuracy (82%, 60% and 73% respectively). Compared with the HFrEF patients in the HM/TPD<38.3% group ( n =36), RR and cardiac function improved more significantly in the HM/TPD≥38.3% group ( n =64) (all P <0.05). Conclusions: Preoperative HM/TPD ratio is an independent factor for predicting RR in patients with HFrEF after CABG, and HM/TPD≥38.3% can accurately predict RR and the improvement of cardiac function after CABG.