Department of Nuclear Medicine, Cardiology and Cardiovascular Surgery Institute, Havana, Cuba, .
Hospital Universitario Juan Ramón Jiménez, Huelva, Spain, .
Nucl Med Commun. 2024 Aug 1;45(8):666-672. doi: 10.1097/MNM.0000000000001860. Epub 2024 May 15.
In this substudy of the Value of Gated-SPECT MPI for Ischemia- Guided PCI of non-culprit vessels in STEMI Patients with Multi vessel Disease after primary PCI trial after primary PCI we aim to assess if infarct size affects conventional measures of dyssynchrony at rest. Additionally, we explore if there is an independent correlation of stress-inducible ischemia with dyssynchrony at rest.
The 48 patients with imaging at randomization were analyzed. Gated-single-photon emission computed tomography (SPECT) MPI with vasodilator stress and technetium-99m-labeled tracers was performed. The phase histogram bandwidth (HBW), phase SD, and entropy were obtained with the QGS software. Correlation between dyssynchrony at rest and infarct size and inducible ischemia was performed using the Spearman test.
According to normal database limits dyssynchrony parameters at rest were abnormal for men. In women only HBW was abnormal. Correlation between the summed rest score with dyssynchrony was significant only for entropy ( P = 0.035). No correlation was observed for dyssynchrony and stress-induced ischemia.
Entropy, as a measure of dyssynchrony, has potential in the assessment of patients with STEMI and multivessel disease after primary PCI. Smaller residual myocardial scars in PCI-reperfused patients with STEMI may contribute to the lack of correlation between dyssynchrony at rest and infarct size and stress-induced ischemia, respectively.
在这项 VALUE 研究的子研究中，我们旨在评估梗塞面积是否会影响静息状态下常规的失同步测量值，该研究为多支病变 ST 段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PCI）后，采用门控单光子发射计算机断层扫描（SPECT）MPI 对非罪犯血管进行缺血指导 PCI。此外，我们还探讨了应激诱导缺血与静息状态下失同步是否存在独立相关性。
对随机分组时进行影像学检查的 48 例患者进行分析。采用门控单光子发射计算机断层扫描（SPECT）MPI 联合血管扩张剂应激和锝-99m 标记示踪剂进行检查。采用 QGS 软件获得相位直方图带宽（HBW）、相位标准差（SD）和熵。采用 Spearman 检验对静息状态下的失同步与梗塞面积和诱导性缺血之间的相关性进行分析。
根据正常数据库的限制，男性静息状态下的失同步参数异常。仅女性 HBW 异常。静息状态下总评分与失同步的相关性仅在熵方面具有统计学意义（P=0.035）。失同步与应激诱导缺血之间未观察到相关性。
熵作为失同步的一种测量方法，在评估 STEMI 患者和多支病变患者直接 PCI 后可能具有一定的应用潜力。STEMI 患者 PCI 再灌注后残余心肌瘢痕较小，可能导致静息状态下失同步与梗塞面积和应激诱导缺血之间缺乏相关性。
