Department of Nuclear Medicine First Hospital of Shanxi Medical University Taiyuan China.
Collaborative Innovation Center for Molecular Imaging of Precision Medicine Shanxi Medical University Taiyuan China.
J Am Heart Assoc. 2024 Sep 3;13(17):e032169. doi: 10.1161/JAHA.123.032169. Epub 2024 Aug 27.
Adverse left ventricular remodeling is a significant cardiovascular predictor for patients with coronary artery disease and preserved left ventricular ejection fraction (LVEF). However, the remodeling indexes reflecting left ventricular spherization by myocardial perfusion imaging are underexplored.
727 patients (mean age 59.8±13.5 years, 329 women) diagnosed or suspected coronary artery disease with preserved LVEF who underwent resting myocardial perfusion imaging were retrospectively enrolled. The myocardial perfusion imaging findings including the total perfusion deficit and sphericity indexes (shape index (SI) and eccentricity index (EI) obtained from gated (QGS) and non-gated (QPS) images) were collected. Major adverse cardiovascular events (MACE) were followed up for 45.1±22.0 months. All patients were divided into 4 subgroups based on total perfusion deficit at 10% and LVEF at 65%. Univariable comparative analyses were performed in 5 cohorts (all patients and 4 subgroups). Patients who experienced MACE displayed higher SI and/or lower EI (all <0.05). Kaplan-Meier survival analyses suggested significant differences for SI in all 5 cohorts, for EI and EI in 4 cohorts, and for end-systolic and end-diastolic SI in 3 cohorts (all <0.05). Multivariate Cox analysis showed that abnormal SI and EI remained statistically significant predictors for MACE after adjusting for total perfusion deficit, LVEF, and other confounding factors.
For patients diagnosed or suspected of coronary artery disease with preserved or supra-normal LVEF, resting sphericity indexes by myocardial perfusion imaging displayed incremental long-term prognostic value. Among these indicators, SI is particularly promising across different perfusion or preserved functional conditions.
对于左心室射血分数（LVEF）保留的冠心病患者，不良的左心室重构是重要的心血管预测因素。然而，通过心肌灌注成像反映左心室球形化的重构指标尚未得到充分探索。
回顾性纳入 727 例（平均年龄 59.8±13.5 岁，329 例女性）经静息心肌灌注成像诊断或疑诊冠心病且 LVEF 保留的患者。收集心肌灌注成像结果，包括总灌注缺损和球形化指数（形状指数（SI）和离心率指数（EI），来自门控（QGS）和非门控（QPS）图像）。随访 45.1±22.0 个月，记录主要不良心血管事件（MACE）。所有患者根据总灌注缺损 10%和 LVEF 65%分为 4 个亚组。在 5 个队列中进行单变量比较分析（所有患者和 4 个亚组）。发生 MACE 的患者 SI 和/或 EI 较高（均<0.05）。Kaplan-Meier 生存分析表明，5 个队列中 SI 差异均有统计学意义，4 个队列中 EI 和 EI 差异均有统计学意义，3 个队列中 ES 和 ED SI 差异均有统计学意义（均<0.05）。多变量 Cox 分析显示，在校正总灌注缺损、LVEF 和其他混杂因素后，异常 SI 和 EI 仍然是 MACE 的统计学显著预测因素。
对于诊断或疑诊冠心病且 LVEF 保留或高于正常的患者，静息心肌灌注成像的球形化指数具有额外的长期预后价值。在这些指标中，SI 在不同的灌注或保留功能条件下具有特别的应用前景。
