正常與近似正常心肌血流灌注掃描之醫療資料分析－兩年內重大心臟血管不良事件風險

Normal and Near Normal Myocardial Perfusion Imaging Data Analysis: Two-Year Major Adverse Cardiac Event

唐麗華(Li-Hua TANG) ； 黃奕琿(Yih-Hwen HUANG) ； 陳建榮(Chien-Jung CHEN) ； 顏若芳(Ruoh-Fang YEN) ； 蔡旻璇(Min-Hsuan TSAI) ； 陳佳慧(Cheryl Chia-Hui CHEN)

《護理雜誌》 69卷3期 (2022/06) Pp. 58-67

https://doi.org/10.6224/JN.202206_69(3).09

摘要

背景：心肌血流灌注掃描（myocardial perfusion imaging, MPI）廣泛應用在檢查心肌缺血及冠狀動脈疾病，目前對於MPI檢查正常與日後發生重大心臟血管不良事件（major adverse cardiac event, MACE）的現況尚不清楚。目的：針對接受藥物性MPI檢查之病人（≥ 20歲），且MPI結果為正常或接近正常者，分析其2年內MACE的發生率及危險因子。方法：此為回顧性病歷觀察研究，資料收集期間為2017年1月至2017年12月止，利用核醫報告系統取得病人資料，其接受加藥式MPI檢查結果為正常或接近正常者，並與醫療資料庫進行串接；採描述性統計及羅吉斯迴歸分析等進行資料分析。結果：研究納入1,629人，平均年齡為70.4歲，男女比例相當。MPI正常組有387人，兩年內發生MACE有61人（15.8%）；MPI接近正常組有1,242人，兩年內發生MACE有206人（16.6 %）；此外，年齡較高、男性、MPI檢查較差的壓力態左心室射出分率是MACE的危險因子。結論／實務應用：本研究發現MPI正常並非零風險，2年內發生MACE機率有15.8%，MPI接近正常則16.6%，對於此類病人，清楚的衛教MACE風險及危險因子控管是照護的重點。

關鍵字

心肌血流灌注掃描 ； 重大心臟血管不良事件 ； 心肌缺血 ； 冠狀動脈疾病

並列摘要

Background: Myocardial perfusion imaging (MPI) is the method most commonly used to assess patients with suspected coronary artery disease for the presence of myocardial ischemia and risk of subsequent adverse cardiac events. Studies are limited on the incidence of major adverse cardiac event (MACE) in patients with normal MPI results. Purpose: The aim of this study was to investigate the incidence and risk factors of MACE in patients with normal or near-normal MPI results. Method: In this single-center retrospective chart review study, patients who had received MPI tests at a nuclear medicine department of a medical center in 2017 were consecutively enrolled. All of the participants in this study were patients with normal or near-normal MPI results, and were followed for two years to assess the incidence of MACE (death, hospitalized for percutaneous coronary intervention; CABG, heart failure and stroke). Participants with or without MACE were compared to determine whether demographic, comorbidity, and MPI data were significant risk factors. Results: Of the 1,629 participants (age = 70.4 ± 11.3 years, 49.4% male) enrolled, 387 (23.8%) were classified into the normal MPI group and 1,242 (76.2%) were classified into the near-normal MPI group. Notably, 61 participants (15.8%) in the normal MPI group and 206 (16.6%) in the near-normal MPI group experienced MACE events during the two-year follow-up. The risk factors of MACE identified in this study included being older in age, being male, and having poor myocardial perfusion parameters (i.e., ejection fraction) during MPI. Conclusions/Implications for Practice: Over the two-year study period, 15.8% of the participants with normal MPI results and 16.6% of those with near-normal MPI results experienced major adverse cardiac events. Thus, it is critical to inform patients regarding the potential risk of MACE risk and to educate them on how to mitigate this risk by actively managing their hyperlipidemia level and left ventricular ejection fraction.

並列關鍵字

myocardial perfusion imaging ； major adverse cardiac event ； myocardial ischemia ； coronary artery disease

參考文獻

Bulkley, B. H., Rouleau, J. R., Whitaker, J. Q., Strauss, H. W., & Pitt, B. (1977). The use of 201Thallium for myocardial perfusion imaging in sarcoid heart disease. Chest, 72(1), 27–32. https://doi.org/10.1378/chest.72.1.27

Gibbons, R. J. (2000). Myocardial perfusion imaging. Heart, 83(3), 355–360. https://doi.org/10.1136/heart.83.3.355

Ishihara, M., Onoguchi, M., Taniguchi, Y., & Shibutani, T. (2017). Comparison of conventional and cadmium-zinc-telluride single-photon emission computed tomography for analysis of thallium-201 myocardial perfusion imaging: An exploratory study in normal databases for different ethnicities. The International Journal of Cardiovascular Imaging, 33(12), 2057–2066. https://doi.org/10.1007/s10554-017-1205-0

Jaarsma, C., Leiner, T., Bekkers, S. C., Crijns, H. J., Wildberger, J. E., Nagel, E., Nelemans, P. J., & Schalla, S. (2012). Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: A meta-analysis. Journal of the American College of Cardiology, 59(19), 1719–1728. https://doi.org/10.1016/j.jacc.2011.12.040

Kassab, K., Hussain, K., Torres, A., Iskander, F., Iskander, M., Khan, R., & Doukky, R. (2022). The diagnostic and prognostic value of near-normal perfusion or borderline ischemia on stress myocardial perfusion imaging. Journal of Nuclear Cardiology, 29(2), 826–835. https://doi.org/10.1007/s12350-020-02375-y