Zhou Y H, Lu Y, Meng J J, Mou T T, Bai Y J, Zhang S, Zheng Y Q, Deng Q J, Jiao J, Chang Z, Xie X F, Yun M K, Mi H Z, Li X, Zhang X L
Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2023 Jun 24;51(6):626-632. doi: 10.3760/cma.j.cn112148-20220919-00730.
To evaluate the prognostic value of left ventricular ejection fraction (LVEF) reserve assessed by gated SPECT myocardial perfusion imaging (SPECT G-MPI) for major adverse cardiovascular event (MACE) in patients with coronary artery disease. This is a retrospective cohort study. From January 2017 to December 2019, patients with coronary artery disease and confirmed myocardial ischemia by stress and rest SPECT G-MPI, and underwent coronary angiography within 3 months were enrolled. The sum stress score (SSS) and sum resting score (SRS) were analyzed by the standard 17-segment model, and the sum difference score (SDS, SDS=SSS-SRS) was calculated. The LVEF at stress and rest were analyzed by 4DM software. The LVEF reserve (ΔLVEF) was calculated (ΔLVEF=stress LVEF-rest LVEF). The primary endpoint was MACE, which was obtained by reviewing the medical record system or by telephone follow-up once every twelve months. Patients were divided into MACE-free and MACE groups. Spearman correlation analysis was used to analyze the correlation between ΔLVEF and all MPI parameters. Cox regression analysis was used to analyze the independent factors of MACE, and the optimal SDS cutoff value for predicting MACE was determined by receiver operating characteristic curve (ROC). Kaplan-Meier survival curves were plotted to compare the difference in the incidence of MACE between different SDS groups and different ΔLVEF groups. A total of 164 patients with coronary artery disease [120 male; age (58.6±10.7) years] were included. The average follow-up time was (26.5±10.4) months, and a total of 30 MACE were recorded during follow-up. Multivariate Cox regression analysis showed that SDS (=1.069, 95%: 1.005-1.137, =0.035) and ΔLVEF (=0.935, 95%: 0.878-0.995, =0.034) were independent predictors of MACE. According to ROC curve analysis, the optimal cut-off to predict MACE was a SDS of 5.5 with an area under the curve of 0.63 (=0.022). Survival analysis showed that the incidence of MACE was significantly higher in the SDS≥5.5 group than in the SDS<5.5 group (27.6% vs. 13.2%, =0.019), but the incidence of MACE was significantly lower in the ΔLVEF≥0 group than in theΔLVEF<0 group (11.0% vs. 25.6%, =0.022). LVEF reserve (ΔLVEF) assessed by SPECT G-MPI serves as an independent protective factor for MACE, while SDS is an independent risk predictor in patients with coronary artery disease. SPECT G-MPI is valuable for risk stratification by assessing myocardial ischemia and LVEF.
评估门控单光子发射计算机断层扫描心肌灌注成像（SPECT G-MPI）所测定的左心室射血分数（LVEF）储备对冠心病患者主要不良心血管事件（MACE）的预后价值。这是一项回顾性队列研究。纳入2017年1月至2019年12月期间患有冠心病且通过负荷及静息SPECT G-MPI确诊心肌缺血，并在3个月内接受冠状动脉造影的患者。采用标准的17节段模型分析负荷总分（SSS）和静息总分（SRS），并计算总分差值（SDS，SDS = SSS - SRS）。通过4DM软件分析负荷及静息时的LVEF。计算LVEF储备（ΔLVEF，ΔLVEF = 负荷LVEF - 静息LVEF）。主要终点为MACE，通过查阅病历系统或每12个月进行一次电话随访获取。患者分为无MACE组和MACE组。采用Spearman相关性分析分析ΔLVEF与所有MPI参数之间的相关性。采用Cox回归分析分析MACE的独立因素，并通过受试者工作特征曲线（ROC）确定预测MACE的最佳SDS截断值。绘制Kaplan-Meier生存曲线比较不同SDS组和不同ΔLVEF组MACE发生率的差异。共纳入164例冠心病患者[男性120例；年龄（58.6±10.7）岁]。平均随访时间为（26.5±10.4）个月，随访期间共记录30例MACE。多因素Cox回归分析显示，SDS（=1.069，95%：1.005 - 1.137，=0.035）和ΔLVEF（=0.935，95%：0.878 - 0.995，=0.034）是MACE的独立预测因素。根据ROC曲线分析，预测MACE的最佳截断值为SDS为5.5，曲线下面积为0.63（=0.022）。生存分析显示，SDS≥5.5组的MACE发生率显著高于SDS<5.5组（27.6%对13.2%，=0.019），但ΔLVEF≥0组的MACE发生率显著低于ΔLVEF<0组（11.0%对25.6%，=0.022）。SPECT G-MPI评估的LVEF储备（ΔLVEF）是MACE的独立保护因素，而SDS是冠心病患者的独立风险预测因素。SPECT G-MPI通过评估心肌缺血和LVEF进行风险分层具有重要价值。
