风险分层与手术前心肌输液成像术的风险分层
Dayoung Kim1, Valerie Builoff2, Tali Sharir3
1Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB, Canada.
European journal of nuclear medicine and molecular imaging
|October 27, 2025
概括
在非心脏手术之前,手术前心肌输液成像 (MPI) 可以识别患有死亡或心肌梗塞 (MI) 风险较高的患者. 休息 perfusion 异常是不良心血管事件的关键预测因素.
科学领域:
- 心脏病学 心脏病学
- 心血管成像 - 心血管成像
- 在外科手术期间的医学.
背景情况:
- 心肌输液成像 (MPI) 用于在接受非心脏手术的患者中进行心脏风险分层.
- 支持MPI作用的现有数据仅限于单一中心研究,并且早于当代冠状动脉疾病 (CAD) 疗法.
- 在当前的治疗环境中,手术前MPI的临床实用性需要重新评估.
研究的目的:
- 评估术前检测指示与心血管结果 (死亡或心肌梗塞 (MI)) 之间的关联.
- 在接受非心脏手术的患者中确定死亡或心肌梗塞的预测因素,这些患者接受了手术前的MPI.
- 评估手术前MPI转诊对患者结果的影响.
主要方法:
- 国际多中心REFINE-SPECT注册表的分析,包括32,711名患者.
- 将患者分为术前检测指示和非术前检测组.
- 评估手术前检测与死亡或心脏病发作的相关性,并对手术前检测队列进行进一步分析.
主要成果:
- 被转诊进行手术前检测的患者死亡或心脏病发作的发生率显著更高 (4.4%对1.6%,p < 0.001).
- 在手术前测试组中,压力,休息和缺血性总 perfusion 缺陷与死亡或心脏病发作有关.
- 休息总 perfusion 缺陷独立预测死亡或MI (aHR 1.25,95% CI 1.07-1.45),而药理应力测试没有 (aHR 0.88,95% CI 0.70-1.12).
结论:
- 手术前的SPECT MPI识别了患有心血管风险增加的患者,可能是由于选择偏差或未测量的混因素.
- 在MPI中休息 perfusion 异常对于识别高风险患者非常有价值.
- 这些发现可以为手术患者的术后护理策略提供信息.
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