疑似心肌缺血女性左心室能量模型预后:NHLBI赞助的女性缺血症状分析研究
Original Article

疑似心肌缺血女性左心室能量模型预后:NHLBI赞助的女性缺血症状分析研究

Mark Doyle1, Nicole Weinberg2,*, Gerald M. Pohost3,*, C. Noel Bairey Merz2,*, Leslee J. Shaw2,*, George Sopko4,*, Anthon Fuisz5,*, William J. Rogers6,*, Edward G. Walsh7,*, B. Delia Johnson8,*, Barry L. Sharaf7,*, Carl J. Pepine9,*, Sunil Mankad1,*, Steven E. Reis8,*, Geetha Rayarao1,*, Diane A. Vido1,*, Vera Bittner6,*, Lindsey Tauxe6,*, Marian B. Olson8,*, Sheryl F. Kelsey8,*, Robert WW Biederman1,*

1Allegheny General Hospital, Pittsburgh, PA, USA; 2Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA; 3Keck Medical Center, University of Southern California, Los Angeles, CA, USA; 4National Heart Lung and Blood Institute, NIH, USA; 5Department of Medicine University of Washington, Washington DC, USA; 6The University of Alabama at Birmingham, AL, USA; 7Brown University, Providence, RI, USA; 8Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; 9University of Florida, Gainesville, FL, USA

*These authors contributed equally to this work.

Corresponding to: Mark Doyle, PhD. Division of Cardiology, CV MRI Center, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212-4772, USA. Email: mdoyle@wpahs.org.

目的: 评估疑有心肌缺血女性患者左心室能量模型的预后价值。

背景: 目前关于疑有心肌缺血女性患者左心室内部能量应用的预后价值尚有待研究。 方法 伴心肌缺血症状的女性患者[n = 227,平均年龄59±12岁(范围31-86岁)]行心肌灌注显像用于评估局部灌注缺损,同时行SPECT(n=207)及MRI(n=203)以测量左心室容积。在随访期间(40±17个月),通过MRI及门控SPECT变量分析重大心血管不良事件(MACE,死亡,心肌梗死或因充血性心衰住院)的首次发生时间。

结果: 31例患者出现了不良事件(14%)。每种检查法都生成了多变量Cox模型:对于MRI,变量为内部能量应用和心室壁厚(卡方检验34,P <0.005),SEPCT变量为内部能量应用和心脏收缩压(卡方检验34,P <0.005)。在对患者年龄、病史及Framingham风险评分进行调整后,多变量Cox模型仍可用于预后。在每一例Cox模型中,如果患者模型风险为阳性,则该患者有高风险,反之则不具有高风险。MACE时间Kaplan-Meier曲线分析显示了MR(log rank 25.3,P<0.001)及门控SEPCT(log rank 18.2,P<001)高风险及低风险模型。

结论: 通过MR或门控SEPCT评估得出,在疑有心肌缺血的女性患者中,与低射血分数及心肌灌注缺损相比,高内部能量利用具有更高的预后价值。

关键词:MRI,SPECT,高血压,心肌缺血


Submitted Apr 20, 2013. Accepted for publication May 06, 2013.

doi: 10.3978/j.issn.2223-3652.2013.05.02


Cite this article as: Doyle M, Weinberg N, Pohost GM, Bairey Merz CN, Shaw LJ, Sopko G, Fuisz A, Rogers WJ, Walsh EG, Johnson BD, Sharaf BL, Pepine CJ, Mankad S, Reis SE, Rayarao G, Vido DA, Bittner V, Tauxe L, Olson MB, Kelsey SF, Biederman RW. Left ventricular energy model predicts adverse events in women with suspected myocardial ischemia: results from the NHLBI-sponsored women’s ischemia syndrome evaluation (WISE) study. Cardiovasc Diagn Ther 2013;3(2):64-72. doi: 10.3978/j.issn.2223-3652.2013.05.02