Fondazione Toscana G. Monasterio, Pisa, Italy.
Scuola Superiore Sant'Anna, Pisa, Italy.
Eur J Nucl Med Mol Imaging. 2021 Oct;48(11):3502-3511. doi: 10.1007/s00259-021-05312-4. Epub 2021 Mar 18.
Coronary angiography has been recommended in all patients with suspected chronic coronary syndrome and left ventricular ejection fraction (LVEF) ≤35%. The role of ischemia testing, for example, through stress-rest myocardial perfusion scintigraphy (MPS), for risk prediction is not well established.
We evaluated 1576 consecutive patients referred to MPS and stratified into 3 LV ejection fraction (LVEF) categories: ≤35%, 36-49%, and ≥ 50%.
Patients with LVEF ≤35% were oldest, most often men, and with the highest likelihood of prior early (elective or urgent) coronary revascularization. They had also the highest values or summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS), as well as the highest frequency of significant coronary artery disease, and a greater number of diseased vessels.
FOLLOW-UP: In this subgroup, 32 cardiovascular death or non-fatal myocardial infarction (MI) (21%), 35 all-cause deaths (22%), and 37 cardiovascular deaths, non-fatal MI, or late revascularizations (27%) were recorded with the shortest survival among all LVEF classes. SRS, SSS, and SDS had very low area under the curve values for the prediction of the 3 endpoints, with very high cut-offs, respectively. SRS and SSS cut-offs predicted a worse outcome in Cox regression models including the number of diseased vessels and early revascularization.
In patients with LVEF ≤35%, SRS and SSS are less predictive of outcome than in patients with better preserved systolic dysfunction, but their cut-offs retain independent prognostic significance from the number of vessels with significant stenoses and from early revascularization.
疑似慢性冠状动脉综合征和左心室射血分数（LVEF）≤35%的所有患者均推荐进行冠状动脉造影。例如，通过应激-静息心肌灌注闪烁显像（MPS）进行缺血检测，其用于风险预测的作用尚未得到充分确立。
我们评估了 1576 例连续接受 MPS 检查的患者，并将其分为 3 个左心室射血分数（LVEF）类别：≤35%、36-49%和≥50%。
LVEF≤35%的患者年龄最大，多数为男性，且先前早期（选择性或紧急）冠状动脉血运重建的可能性最高。他们的总和应激评分（SSS）、总和静息评分（SRS）和总和差异评分（SDS）值也最高，以及冠状动脉疾病的发生率最高，病变血管数量也最多。
在此亚组中，32 例心血管死亡或非致死性心肌梗死（MI）（21%）、35 例全因死亡（22%）和 37 例心血管死亡、非致死性 MI 或晚期血运重建（27%），所有 LVEF 亚组中生存时间最短。SRS、SSS 和 SDS 预测这 3 个终点的曲线下面积值非常低，截断值非常高。SRS 和 SSS 截断值在包括病变血管数量和早期血运重建的 Cox 回归模型中预测了更差的结局。
在 LVEF≤35%的患者中，SRS 和 SSS 对预后的预测能力不如左心室收缩功能保存较好的患者，但它们的截断值仍然与有意义的狭窄血管数量和早期血运重建具有独立的预后意义。
