核素心肌断层显像定量评估左心室重构程度
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摘要
左心室重构(left ventricular remodeling, LVRM)是指急性心肌梗塞(acute myocardial infarction, AMI)后梗死区的心肌变薄,拉伸,左心室(left ventricular,LV)心腔扩大和非梗死区心肌肥厚。这一过程最终导致心力衰竭和心脏性猝死的发生率增加,并与患者的不良预后密切相关。因此,如何简便无创、客观的准确判断LVRM的有无及其程度,并对其进行定量化,已成为临床亟待解决的问题之一。
门控正电子发射断层成像术(positron emission tomography, PET)心肌代谢断层显像在提供心肌血流灌注和心肌存活信息的同时,提供LV的功能信息和部分形态学信息。本研究根据核素心肌断层显像提供的LV的形态学信息,在原有的表示左心室整体重构程度的球形指标(spherical index, SI)的基础上提出新的指标包括水平长轴(horizontal long-axis, HLA)“倒八字”程度指标(divergent pattern index, DPI)、短轴横径比(horizontal diameter ratio, HDR)和短轴纵径比(longitudinal diameter ratio, LDR)表示左心室局部重构程度。并基于矩阵实验室(Matrix Laboratory, MATLAB)编程语言开发一套软件实现对SI、DPI、HDR和LDR的量化。
本研究对33位患者(包括21位临床诊断为室壁瘤的患者和12位临床诊断为心梗的患者)的舒张末期PET心肌代谢显像进行定量分析。将定量分析得到的SI与分析对应MRI图像得到的EDV、ESV和EF做相关性分析,得出SI与EDV和ESV在0.01的显著性水平(双侧)上显著正相关,相关系数分别为0.598和0.615。与EF在0.01的显著性水平(双侧)上显著负相关,相关系数为0.587。将定量分析得到的HLA断层DPI、短轴HDR和LDR与专家对HLA和垂直长轴(vertical long-axis, VLA)断层“倒八字”程度的打分做相关性分析,得出LV前壁、中间段HLA断层DPI以及短轴HDR与专家打分在0.01的显著性水平(双侧)上显著正相关,相关系数分别为0.763、0.709、0.722。对LV前壁、中间段HLA断层DPI和短轴HDR做进一步的验证。从33位患者中随机抽取18位患者,将分析18位患者舒张末期PET心肌代谢显像得到的LV前壁、中间段HLA断层DPI和短轴HDR与专家对LV前壁、中间段HLA断层“倒八字”程度的打分做相关和回归分析,根据各自的回归直线,得出专家打分为2.5分时对应的LV前壁、中间段HLA断层DPI值和短轴HDR值,以这些值为阈值对剩下的15位患者进行诊断。得出,以前壁DPI对患者进行诊断时假阳性率(false positive rate, FPR)为0,假阴性率(false negative rate, FNR)为38%,准确率为80%；以中间段DPI对患者进行诊断时FPR为0,FNR为29%,准确率为87%；以短轴HDR对患者进行诊断,其FPR为0,FNR为42%,准确率为80%。
综上所述,SI可以用来表示左心室整体的重构程度,LV前壁、中间段HLA断层DPI以及短轴HDR可以用来表示左心室局部的重构程度。
Cardiovascular disease is one of the dieases that may severely harm middle-aged and old people's health and even lead death, It is anextremely common disease in Euramerican countries. In recent years, the incidence of cardiovascular disease exhibits a rapid rising trend in China. Left Ventricular remodeling (LVRM) refers to the changes in size, shape, and function of the heart after acute myocardial infarction (AMI). Ultimately, LVRM, which is closely associated with the poor output of patients, may result in heart failure and increase the incidence of sudden cardiac death. As some researches have shown, patients with serious LVRM may not recover, after successfully coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Therefore, how to judge and quantify the extent of LVR accurately and noninvasively is one of the clinical problems need to be solved.
Myocardial metabolic imaging with positron emission tomography (PET) not only provide myocardial perfusion and myocardial viability information but also the function and morphology of the LV. According to the morphology information of LV provided by the myocardial nuclear medicine imaging, this study define some new index to quantify the local extent of LVRM, including DPI (divergent pattern index) of HLA (Horizontal long-axis), short axis HDR (horizontal diameter ratio) and LDR (longitudinal diameter ratio), on the basis of SI (spherical index) representing the overall degree of LVRM.
This research mainly based on end-diastolic PET myocardial metabolic imaging of 33 patients (including 21 aneurysm patients and 12 myocardial infraction patients). The correlation coefficients between SI derived by quantitative analysis of end diastolic PET myocardial metabolic imaging and EDV、ESV derived by analysis of MRI images are 0.598 and 0.615, significantly at the 0.01 level (bilateral). The correlation coefficient between SI and EF derived by analysis of MRI images is-0.587, significantly at the 0.01 level (bilateral). The correlation coefficients between DPI of LV anterior、middle HLA faultage, short axis HDR and score for divergent pattern degree of HLA and VLA (Vertical Long-axis) faultage derived by expert expert macroscopic observation are 0.763、0.709、0.722, significantly at the 0.01 level (bilateral). Do further verification on the LV anterior、middle HLA faultage, short axis HDR. We selected 18 patients from 33 patients randomly, then did relevant and regression analysis between DPI of LV anterior、middle HLA faultage, short axis HDR and score for divergent pattern degree of HLA and VLA (Vertical Long-axis) faultage. According to the regression line respectively, we obtained the value of LV anterior、middle HLA faultage DPI and short axis HDR corresponding 2.5 points, which were used to diagnose the remaining 15 patients. When diagnose patient with LV anterior HLA faultage DPI, the false positive rate (FPR) is 0, false negative rate (FNR) was 38%, accuracy was 80%; with LV middle HLA faultage DPI, the FPR was 0, FNR was 29%, accuracy was 87%; with short axis HDR, the FPR is 0, FNR was 42%, accuracy was 80%.
At last, we concluded that SI can be used to represent the overall degree of LVRM, DPI of LV anterior, middle HLA and short axis HDR can be used to represent the local degree of LVRM.
门控正电子发射断层成像术(positron emission tomography, PET)心肌代谢断层显像在提供心肌血流灌注和心肌存活信息的同时,提供LV的功能信息和部分形态学信息。本研究根据核素心肌断层显像提供的LV的形态学信息,在原有的表示左心室整体重构程度的球形指标(spherical index, SI)的基础上提出新的指标包括水平长轴(horizontal long-axis, HLA)“倒八字”程度指标(divergent pattern index, DPI)、短轴横径比(horizontal diameter ratio, HDR)和短轴纵径比(longitudinal diameter ratio, LDR)表示左心室局部重构程度。并基于矩阵实验室(Matrix Laboratory, MATLAB)编程语言开发一套软件实现对SI、DPI、HDR和LDR的量化。
本研究对33位患者(包括21位临床诊断为室壁瘤的患者和12位临床诊断为心梗的患者)的舒张末期PET心肌代谢显像进行定量分析。将定量分析得到的SI与分析对应MRI图像得到的EDV、ESV和EF做相关性分析,得出SI与EDV和ESV在0.01的显著性水平(双侧)上显著正相关,相关系数分别为0.598和0.615。与EF在0.01的显著性水平(双侧)上显著负相关,相关系数为0.587。将定量分析得到的HLA断层DPI、短轴HDR和LDR与专家对HLA和垂直长轴(vertical long-axis, VLA)断层“倒八字”程度的打分做相关性分析,得出LV前壁、中间段HLA断层DPI以及短轴HDR与专家打分在0.01的显著性水平(双侧)上显著正相关,相关系数分别为0.763、0.709、0.722。对LV前壁、中间段HLA断层DPI和短轴HDR做进一步的验证。从33位患者中随机抽取18位患者,将分析18位患者舒张末期PET心肌代谢显像得到的LV前壁、中间段HLA断层DPI和短轴HDR与专家对LV前壁、中间段HLA断层“倒八字”程度的打分做相关和回归分析,根据各自的回归直线,得出专家打分为2.5分时对应的LV前壁、中间段HLA断层DPI值和短轴HDR值,以这些值为阈值对剩下的15位患者进行诊断。得出,以前壁DPI对患者进行诊断时假阳性率(false positive rate, FPR)为0,假阴性率(false negative rate, FNR)为38%,准确率为80%；以中间段DPI对患者进行诊断时FPR为0,FNR为29%,准确率为87%；以短轴HDR对患者进行诊断,其FPR为0,FNR为42%,准确率为80%。
综上所述,SI可以用来表示左心室整体的重构程度,LV前壁、中间段HLA断层DPI以及短轴HDR可以用来表示左心室局部的重构程度。
Cardiovascular disease is one of the dieases that may severely harm middle-aged and old people's health and even lead death, It is anextremely common disease in Euramerican countries. In recent years, the incidence of cardiovascular disease exhibits a rapid rising trend in China. Left Ventricular remodeling (LVRM) refers to the changes in size, shape, and function of the heart after acute myocardial infarction (AMI). Ultimately, LVRM, which is closely associated with the poor output of patients, may result in heart failure and increase the incidence of sudden cardiac death. As some researches have shown, patients with serious LVRM may not recover, after successfully coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Therefore, how to judge and quantify the extent of LVR accurately and noninvasively is one of the clinical problems need to be solved.
Myocardial metabolic imaging with positron emission tomography (PET) not only provide myocardial perfusion and myocardial viability information but also the function and morphology of the LV. According to the morphology information of LV provided by the myocardial nuclear medicine imaging, this study define some new index to quantify the local extent of LVRM, including DPI (divergent pattern index) of HLA (Horizontal long-axis), short axis HDR (horizontal diameter ratio) and LDR (longitudinal diameter ratio), on the basis of SI (spherical index) representing the overall degree of LVRM.
This research mainly based on end-diastolic PET myocardial metabolic imaging of 33 patients (including 21 aneurysm patients and 12 myocardial infraction patients). The correlation coefficients between SI derived by quantitative analysis of end diastolic PET myocardial metabolic imaging and EDV、ESV derived by analysis of MRI images are 0.598 and 0.615, significantly at the 0.01 level (bilateral). The correlation coefficient between SI and EF derived by analysis of MRI images is-0.587, significantly at the 0.01 level (bilateral). The correlation coefficients between DPI of LV anterior、middle HLA faultage, short axis HDR and score for divergent pattern degree of HLA and VLA (Vertical Long-axis) faultage derived by expert expert macroscopic observation are 0.763、0.709、0.722, significantly at the 0.01 level (bilateral). Do further verification on the LV anterior、middle HLA faultage, short axis HDR. We selected 18 patients from 33 patients randomly, then did relevant and regression analysis between DPI of LV anterior、middle HLA faultage, short axis HDR and score for divergent pattern degree of HLA and VLA (Vertical Long-axis) faultage. According to the regression line respectively, we obtained the value of LV anterior、middle HLA faultage DPI and short axis HDR corresponding 2.5 points, which were used to diagnose the remaining 15 patients. When diagnose patient with LV anterior HLA faultage DPI, the false positive rate (FPR) is 0, false negative rate (FNR) was 38%, accuracy was 80%; with LV middle HLA faultage DPI, the FPR was 0, FNR was 29%, accuracy was 87%; with short axis HDR, the FPR is 0, FNR was 42%, accuracy was 80%.
At last, we concluded that SI can be used to represent the overall degree of LVRM, DPI of LV anterior, middle HLA and short axis HDR can be used to represent the local degree of LVRM.
引文
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[2]. Amos DJ, White HD. Remodeling after myocardial infarction:An opportunity for early intervention[J]. Basic Research in Cardiology 1997;92(2):69-71.
[3]. Sutton MGS, Sharpe N. Left ventricular remodeling after myocardial infarction Pathophysiology and therapy[J]. Circulation 2000; 101 (25):2981-2988.
[4]. Yousef Z, Redwood SR, Marber MS. Postinfarction left ventricular remodeling:A pathophysiological and therapeutic review[J]. Cardiovascular Drugs and Therapy 2000;14(3):243-252.
[5].刘秀杰,马寄晓主编.临床心肺核医学.第1版[M].北京：北京医科大学中国协和医科大学联合出版社；1993.12-190 p.
[6]. Russell RR, Zaret BL. Nuclear cardiology:Present and future[J]. Current Problems in Cardiology 2006;31(9):557-629.
[7].马寄晓,刘秀杰主编.实用临床核医学.第2版[M].北京：原子能出版社；2002.43-218 p.
[8].金永杰主编.核医学仪器与方法.第1版[M].哈尔滨：哈尔冰工程大学出版社；2009.160-228 p.
[9].陈盛祖主编PET/CT技术原理及肿瘤学应用.第1版[M].北京：人民军医出版社；2007.115-142 p.
[10]. April Mann, CNMT RT(N). GATED MYOCARDIAL PERFUSION IMAGING:A REVIEW. Cewebsourcecom 2011:1-9.
[11]. Konstam MA, Kramer DG, Patel AR, et al. Left Ventricular Remodeling in Heart Failure Current Concepts in Clinical Significance and Assessment[J]. Jacc-Cardiovascular Imaging 2011;4(1):98-108.
[12]. Verma A, Meris A, Skali H, et al. Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction The VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study[J]. Jacc-Cardiovascular Imaging 2008;1(5):582-591.
[13]. Thomson HL, Basmadjian AJ, Rainbird AJ, et al. Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements-A prospective, randomly assigned, blinded study[J]. Journal of the American College of Cardiology 2001;38(3):867-875.
[14]. Bolognese L, Neskovic AN, Parodi G, et al. Left ventricular remodeling after primary coronary angioplasty-Patterns of left ventricular dilation and long-term prognostic implications[J]. Circulation 2002;106(18):2351-2357.
[15]. Bax JJ, Schinkel AFL, Boersma E, et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction post-revascularization and is associated with worse long-term prognosis[J]. European Heart Journal 2004;25:129-129.
[16]. Lipiecki J, Cachin F, Durel N, et al. Influence of infarct-zone viability detected by rest Tc-99m sestamibi gated SPECT on left ventricular remodeling after acute myocardial infarction treated by percutaneous transluminal coronary angioplasty in the acute phase[J]. Journal of Nuclear Cardiology 2004;11(6):673-681.
[17]. Anand IS, Florea VG, Solomon SD, et al. Noninvasive assessment of left ventricular remodeling:Concepts, techniques, and implications for clinical trials[J]. Journal of Cardiac Failure 2002;8(6):S452-S464.
[18]. Harjai KJ, Edupuganti R, Nunez E, et al. Does left ventricular shape influence clinical outcome in heart failure [J]? Clinical Cardiology 2000;23(11):813-819.
[19]. Mannaerts HFJ, van der Heide JA, Kamp O, et al. Early identification of left ventricular remodelling after myocardial infarction, assessed by transthoracic 3D echocardiography[J]. European Heart Journal 2004;25(8):680-687.
[20]. Di Donato M, Dabic P, Castelvecchio S, et al. Left ventricular geometry in normal and post-anterior myocardial infarction patients:sphericity index and'new'conicity index comparisons[J]. European Journal of Cardio-Thoracic Surgery 2006;29:S225-S230.
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