Liu Lu, Abdu Fuad A, Yin Guoqing, Xu Bin, Mohammed Abdul-Quddus, Xu Siling, Lv Xian, Luo Yanru, Zu Lu, Yang Changrui, Zhang Ziyi, Zhou Yuxiao, Cai Haidong, Lv Zhongwei, Xu Yawei, Che Wenliang
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
Department of Cardiology, Clinical Medical College of Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China.
J Nucl Cardiol. 2021 Dec;28(6):3025-3037. doi: 10.1007/s12350-020-02252-8. Epub 2020 Sep 30.
Myocardial perfusion imaging (MPI) with a novel D-SPECT camera maintains excellent prognostic value compared to conventional SPECT. However, information about the relationship between D-SPECT MPI and the prognosis in patients with ischemia and no obstructive coronary artery disease (INOCA) is limited. The objective of this study was to evaluate the prognostic value of MPI with D-SPECT in INOCA and obstructive coronary artery disease (CAD) patients.
All consecutive patients with suspected CAD and without prior CAD who underwent D-SPECT MPI and invasive coronary angiography within 3 months were considered. INOCA and obstructive CAD were defined as < 50% and ≥ 50% coronary stenosis, respectively. Patients were followed-up for the occurrence of major adverse cardiac events (MACE: cardiovascular death, nonfatal myocardial infarction, revascularization, stroke, heart failure and angina-related rehospitalization).
Among 506 patients, 232 (45.8%) were INOCA patients. A total of 33.2% of the INOCA patients had abnormal D-SPECT MPI, whereas 77.7% of the obstructive CAD patients had abnormal D-SPECT MPI. In both groups, patients with abnormal D-SPECT MPI demonstrated higher MACE rates and lower survival free of MACE. In addition, patients with INOCA and abnormal D-SPECT MPI had a poor prognosis similar to that of the obstructive CAD patients. Cox regression analysis showed that the risk-adjusted hazard ratios for abnormal D-SPECT MPI were 2.55 [1.11-5.87] and 2.06 [1.03-4.10] in the INOCA and obstructive CAD patients, respectively.
D-SPECT MPI provides excellent prognostic information, with a more severe prognosis in patients with abnormal D-SPECT MPI. INOCA patients with abnormal D-SPECT MPI experience a poor prognosis similar to that of patients with obstructive CAD.
与传统单光子发射计算机断层扫描（SPECT）相比，使用新型双探头SPECT相机进行心肌灌注成像（MPI）具有出色的预后价值。然而，关于双探头SPECT MPI与无阻塞性冠状动脉疾病（INOCA）的缺血患者预后之间关系的信息有限。本研究的目的是评估双探头SPECT MPI在INOCA和阻塞性冠状动脉疾病（CAD）患者中的预后价值。
纳入所有在3个月内接受双探头SPECT MPI和有创冠状动脉造影的疑似CAD且无既往CAD的连续患者。INOCA和阻塞性CAD分别定义为冠状动脉狭窄<50%和≥50%。对患者进行随访，观察主要不良心脏事件（MACE：心血管死亡、非致命性心肌梗死、血运重建、中风、心力衰竭和心绞痛相关再住院）的发生情况。
在506例患者中，232例（45.8%）为INOCA患者。总共33.2%的INOCA患者双探头SPECT MPI异常，而77.7%的阻塞性CAD患者双探头SPECT MPI异常。在两组中，双探头SPECT MPI异常的患者MACE发生率更高，无MACE生存率更低。此外，INOCA且双探头SPECT MPI异常的患者预后与阻塞性CAD患者相似。Cox回归分析显示，在INOCA和阻塞性CAD患者中，双探头SPECT MPI异常经风险调整后的风险比分别为2.55 [1.11 - 5.87]和2.06 [1.03 - 4.10]。
双探头SPECT MPI提供了出色的预后信息，双探头SPECT MPI异常的患者预后更差。双探头SPECT MPI异常的INOCA患者预后与阻塞性CAD患者相似。
