Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
IRCCS Synlab-SDN, Naples, Italy.
Eur J Nucl Med Mol Imaging. 2022 Dec;50(1):160-167. doi: 10.1007/s00259-022-05948-w. Epub 2022 Sep 2.
Despite myocardial perfusion imaging (MPI) by cadmium-zinc-telluride (CZT) single-photon emission computed tomography (SPECT) camera is largely used in the diagnosis and risk stratification of patients with suspected or known coronary artery disease (CAD), no data are available on the prognostic value of a regional MPI evaluation. We evaluated the prognostic value of regional MPI by the CZT camera in predicting clinical outcomes at the vessel level in patients with available angiographic data.
Five hundred and forty-one subjects with suspected or known CAD referred to 99mTc-sestamibi gated CZT-SPECT cardiac imaging and with available angiographic data were studied. Both regional total perfusion deficit (TPD) and ischemic TPD (ITPD) were calculated separately for each vascular territory (left anterior descending, left circumflex, and right coronary artery). The outcome end points were cardiac death, target vessel-related myocardial infarction, or late coronary revascularization. The prevalence of CAD ≥ 50%, regional stress TPD, and regional ITPD was significantly higher in vessels with events as compared to those without (both P < 0.001). The receiver operating characteristics area under the curve for regional ITPD for the identification of vessel-related events was 0.81 (95% confidence interval 0.75-0.86). An ITPD value of 2.0% provided the best trade-off for identifying the vessel-related event. At multivariable analysis, both CAD ≥ 50% and ITPD ≥ 2.0% resulted in independent predictors of events.
Regional myocardial perfusion assessed by the CZT camera demonstrated good reliability in predicting vessel-related events in patients with suspected or known CAD.
尽管基于碲锌镉（CZT）单光子发射计算机断层扫描（SPECT）相机的心肌灌注成像（MPI）在疑似或已知冠心病（CAD）患者的诊断和风险分层中得到了广泛应用，但尚无关于区域 MPI 评估的预后价值的数据。我们评估了 CZT 相机进行区域 MPI 评估在预测具有可用血管造影数据的患者的血管水平临床结局方面的预后价值。
研究了 541 例疑似或已知 CAD 患者，这些患者接受了 99mTc-甲氧基异丁基异腈门控 CZT-SPECT 心脏成像，并具有可用的血管造影数据。分别为每个血管区域（左前降支、左回旋支和右冠状动脉）计算区域总灌注缺陷（TPD）和缺血性 TPD（ITPD）。终点结局是心脏死亡、靶血管相关心肌梗死或晚期冠状动脉血运重建。与无事件的血管相比，CAD≥50%、区域应激 TPD 和区域 ITPD 的患病率更高（均 P < 0.001）。区域 ITPD 对识别血管相关事件的接受者操作特征曲线下面积为 0.81（95%置信区间 0.75-0.86）。ITPD 值为 2.0% 提供了识别血管相关事件的最佳权衡。在多变量分析中，CAD≥50%和 ITPD≥2.0% 均为事件的独立预测因素。
CZT 相机评估的区域心肌灌注在预测疑似或已知 CAD 患者的血管相关事件方面具有良好的可靠性。
