Patel Krishna K, Lim Phillip, Peri-Okonny Poghni A, Singh Annapoorna, McGhie A Iain, Sabharwal Basera, Agarwal Vikram, Shaw Leslee J, Bateman Timothy M
Department of Medicine (Cardiology), Mount Sinai Fuster Hear Hospital, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Medicine (Cardiology), Mount Sinai Fuster Hear Hospital, New York, NY, USA.
J Nucl Cardiol. 2025 Feb;44:102084. doi: 10.1016/j.nuclcard.2024.102084. Epub 2024 Nov 16.
Transient ischemic dilation (TID) of the left ventricular (LV) cavity is considered a high-risk marker in patients with abnormal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Stress image acquisition with rubidium-82 (Rb) PET occurs at peak stress compared to 30-60 minutes post-stress with SPECT. We aimed to evaluate the prognostic value of TID in patients undergoing Rb PET MPI.
A total of 9878 consecutive patients with LVEF ≥40% undergoing rest/pharmacologic stress Rb PET MPI from 2010 to 2016 were followed for a median of 3.2 years. The primary clinical outcome of cardiac death was assessed after adjusting for pre-test risk, known coronary artery disease (CAD), resting left ventricular ejection fraction (LVEF), summed stress score (SSS), LVEF reserve (LVEF-R), myocardial blood flow reserve (MBFR), and early (90-day) revascularization. Pre-specified interactions between TID and SSS were included to assess potential differences in the prognostic value of TID in patients based on perfusion.
The mean age of the cohort was 69.0 (11.7) years with 56.1% being female, 49.8% having known CAD, and 27.9% having abnormal perfusion (SSS>0). There were 451 cardiac deaths. Higher TID ratios were associated with higher risk of cardiac death, even after accounting for LVEF-R and MBFR (HR per .1 unit increase = 1.25 (1.11, 1.41), P < .001). This was seen in patients with both normal (HR for TID per .1 unit increase = 1.24 (95% CI: 1.01, 1.52), P = .04) and abnormal perfusion (HR for TID per .1 unit increase = 1.14 (95% CI: 1.02, 1.28), P = .03).
TID on rest/stress Rb PET MPI offers independent prognostic value in patients with both normal and abnormal perfusion independent of other risk factors in patients with LVEF ≥40%.
左心室（LV）腔的短暂性缺血性扩张（TID）被认为是单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）异常患者的高风险标志物。与SPECT在应激后30 - 60分钟进行图像采集相比，使用铷 - 82（Rb）PET进行应激图像采集是在应激峰值时进行。我们旨在评估TID在接受Rb PET MPI的患者中的预后价值。
对2010年至2016年期间连续9878例左心室射血分数（LVEF）≥40%且接受静息/药物应激Rb PET MPI的患者进行了中位时间为3.2年的随访。在对检测前风险、已知冠状动脉疾病（CAD）、静息左心室射血分数（LVEF）、应激总分（SSS）、LVEF储备（LVEF - R）、心肌血流储备（MBFR）和早期（90天）血运重建进行校正后，评估心脏死亡的主要临床结局。纳入TID与SSS之间的预先设定的相互作用，以评估基于灌注情况的患者中TID预后价值的潜在差异。
该队列的平均年龄为69.0（11.7）岁，女性占56.1%，已知CAD的患者占49.8%，灌注异常（SSS>0）的患者占27.9%。共有451例心脏死亡。即使在考虑LVEF - R和MBFR后，较高的TID比率仍与较高的心脏死亡风险相关（每增加0.1单位的HR = 1.25（1.11，1.41），P <.001）。在灌注正常（每增加0.1单位TID的HR = 1.24（95% CI：1.01，1.52），P = 0.04）和灌注异常（每增加0.1单位TID的HR = 1.14（95% CI：1.02，1.28），P = 0.03）的患者中均观察到这一情况。
静息/应激Rb PET MPI上的TID在LVEF≥40%的患者中，无论灌注正常与否，均可独立于其他风险因素提供预后价值。
