A multicenter study on the prognostic value of SPECT myocardial blood flow quantitative technique in patients with intermediate stenoses of coronary arteries
10.3760/cma.j.cn321828-20230210-00033
- VernacularTitle:SPECT心肌血流定量技术对冠状动脉临界狭窄病变患者预后价值的多中心研究
- Author:
Ruoxi SUN
1
;
Zekun PANG
;
Rongzheng MA
;
Lei WANG
;
Jie ZHANG
;
Jianming LI
;
Wei FANG
Author Information
1. 北京协和医学院、中国医学科学院阜外医院核医学科，北京 100037
- Keywords:
Coronary artery disease;
Fractional flow reserve, myocardial;
Myocardial perfusion imaging;
Tomography, emission-computed, single-photon;
Technetium Tc 99
- From:
Chinese Journal of Nuclear Medicine and Molecular Imaging
2024;44(3):129-133
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the prognostic value of myocardial flow reserve (MFR) measured by SPECT myocardial blood flow (MBF) quantitative technique in patients with intermediate stenoses of coronary arteries.Methods:From September 2019 to May 2021, patients with intermediate stenoses (50% to 80%) identified by invasive coronary angiography in Fuwai Hospital, Chinese Academy of Medical Sciences, Fuwai Center China Cardiovascular Hospital, and TEDA International Cardiovascular Hospital were prospectively included. All patients underwent a one-day rest/stress SPECT myocardial perfusion imaging (MPI) and SPECT MBF quantification. The radioactivity distribution of each segment of the MPI bullseye polar maps were obtained according to the standard 5-point method to obtain the summed stress score (SSS) and the summed difference score (SDS) to determine the existence of abnormality. ROC curve analysis was used to obtain the optimal prognostic cut-off value for MFR. The primary endpoint was defined as cardiovascular endpoint events. Survival and prognostic analyses were conducted by Kaplan-Meier method and Cox proportional hazard models. The difference of AUCs was analyzed by Delong test.Results:A total of 314 patients (194 males, 120 females; age (59.4±8.6) years) were enrolled. Over a median follow-up duration of 754 (range: 628-914) d, 54 patients had endpoint events. ROC curve showed that the prediction ability of MFR was significantly better than that of conventional MPI (AUCs: 0.713 and 0.512; z=3.76, P<0.001). The optimal prognostic cut-off value for MFR to predict endpoint events in patients with intermediate stenoses was 2.04. Cox multivariate analysis showed that MFR (hazard ratio ( HR)=0.434, 95% CI: 0.282-0.669, P<0.001) was an independent predictor of endpoint events in patients with intermediate stenoses. Kaplan-Meier survival analysis showed that the prevalence of endpoint events in patients with MFR≤2.04 was significantly higher than that in patients with MFR>2.04 (25.4%(43/169) vs 7.6%(11/145); χ2=21.27, P<0.001). Conclusion:The MFR measured by SPECT MBF quantitative technique has an independent predictive value for cardiovascular endpoint events in patients with intermediate stenoses.
