Stoke:CT灌注成像在脑卒中合并心功能受损中的应用

2020-03-17 shaosai MedSci原创

左心室射血分数(LVEF)减低会加重脑卒中后预后。本研究旨在验证灌注计算机体层成像中的动脉输入函数(AIF),尤其是扫描开始至AIF结束(SO-EndAIF)时间能够反映心输出量减少。

背景和目的

左心室射血分数(LVEF)减低会加重脑卒中后预后。本研究旨在验证灌注计算机体层成像中的动脉输入函数(AIF),尤其是扫描开始至AIF结束(SO-EndAIF)时间能够反映心输出量减少。

方法

本回顾性分析纳入了行计算机断层成像的脑卒中患者。数据分析主要分为2部分:(1)验证SO-EndAIF与LVEF间的相关性,所有受试者在脑卒中发生前后6个月行经胸超声心动图检查。LVEF分为正常(≥50%) 或降低(<50%);(2)比较AIF与低灌注体积(定义为延迟超过3秒的区域)及临床预后指标(90天mRS评分)。

结果

共纳入了732例缺血性脑梗死患者,其中有231例行经胸超声心动图的患者进行part I,393例有预后数据的患者行Part II分析。在Part I中 ,正常LVEF(中位数61%)、LVEF降低(中位数 39%)患者分别有193/231 (83.5%) 、38/231 (16.5%)。与正常LVEF组相比,低LVEF组具有明显的SO-EndAIF延长(平均为39.7 versus 26 s; P<0.001),低灌注病灶体积更大(94.9 versus 37.6 mL; P<0.001)。SO-EndAIF时间与EF具有显著相关性,曲线下面积为0.86,以29秒作为最佳截断值鉴别正常和受损EF(曲线下面积为0.77)。在Part II, SO-EndAIF ≥29 s组的低灌注体积(21.8 versus 89.7 mL; P<0.001)和梗死核心体积(12.2 versus 2.3 mL; P<0.0001)要高于SO-EndAIF <29 s;SO-EndAIF ≥29 s的患者获得良好或较佳预后的人数较少(mRS评分 0-1; 40% versus 22%; OR, 2.79; P<0.001, mRS评分0-2; 65% versus 35%; OR, 1.41; P=0.033)。

结论

AIF宽度与急性缺血性脑卒中患者的相关性。自扫描开始到AIF结束时间为29能够准确预测LVEF减低,从而识别脑卒中后预后较差风险的患者。

Garcia-Esperon C, Spratt NJ, Gangadharan S. et al. Computed Tomography Perfusion Identifies Patients With Stroke With Impaired Cardiac Function. DOI: 10.1161/STROKEAHA.119.027255

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    2020-03-17 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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