Prognostic value of abnormal myocardial perfusion assessed by SPECT myocardial perfusion imaging before hematopoietic stem cell transplantation in patients with malignant hematologic diseases
10.3760/cma.j.cn321828-20240703-00245
- VernacularTitle:基于SPECT心肌灌注显像评估造血干细胞移植前心肌灌注异常对恶性血液病患者的预后价值
- Author:
Ke LI
1
;
Yuetao WANG
;
Weiying GU
;
Chun QIU
;
Dongyan WANG
;
Feifei ZHANG
;
Dan JIANG
;
Baosheng MENG
;
Yan LIN
;
Jianfeng WANG
Author Information
1. 苏州大学附属第三医院、常州市第一人民医院核医学科，苏州大学核医学与分子影像临床转化研究所，常州 213003
- Publication Type:Journal Article
- Keywords:
Hematologic diseases;
Hematopoietic stem cell transplantation;
Myocardial perfusion imaging;
Technetium Tc 99m sestamibi;
Ventricular function, left;
Progn
- From:
Chinese Journal of Nuclear Medicine and Molecular Imaging
2025;45(8):475-481
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the presence of chemotherapy-induced abnormal myocardial perfusion using SPECT myocardial perfusion imaging (MPI) in patients with malignant hematologic diseases before hematopoietic stem cell transplantation (HSCT), and to explore its predictive value for mid-to-long-term mortality risk after transplantation.Methods:From March 2016 to August 2022, 139 patients with malignant hematologic diseases (80 males, 59 females; age (45.7±13.0) years) who underwent resting MPI to assess the presence of chemotherapy-induced abnormal myocardial perfusion before HSCT at the First People′s Hospital of Changzhou were prospectively included. Baseline-data were collected and patients were followed up for mid-to-long-term (≥100d) adverse outcomes after transplantation. Overall survival (OS) of each patient was recorded. The χ2 test and independent-sample t test were used for data analysis. Cox regression analysis was utilized to identify independent risk factors affecting OS. Kaplan-Meier method and log-rank test were used for survival analysis. Results:The median follow-up time of 139 patients was 41.6(19.5, 65.6) months, with all-cause mortality of 28.8%(40/139), and the cardiovascular mortality was 42.5%(17/40). The prior cardiotoxic therapies rate (anthracycline dose ≥250mg/m 2) was higher in the death group compared to that in the survival group (15.0% (6/40) vs 5.1% (5/99); χ2=3.87, P=0.049). Pre-transplant abnormal myocardial perfusion rate was also higher in the death group compared to that in the survival group (55.0%(22/40) vs 22.2%(22/99); χ2=15.19, P<0.001). But pre-transplant left ventricular ejection fraction (LVEF) was lower in the death group compared to that in the survival group ((60.4±5.2)% vs (62.9±3.9)%; t=-3.07, P=0.003). Cox multivariate regression analysis showed that the abnormal myocardial perfusion indicated by MPI before transplantation was an independent risk factor affecting OS after HSCT in patients with malignant hematologic diseases (hazard rate ( HR)=2.70, 95% CI: 1.33-5.46, P=0.006). Kaplan-Meier analysis showed the 1-, 2-, 5-year OS rates of patients with the abnormal myocardial perfusion and the normal myocardial perfusion were 73.5%, 69.1%, 49.2% and 94.6%, 89.9%, 81.6%, respectively, with significant difference ( χ2=17.01, P<0.001). Conclusions:Patients with abnormal myocardial perfusion detected by MPI before HSCT for malignant hematologic diseases have a poorer prognosis, characterized by lower post-transplantation OS rates. The utilization of MPI for assessing abnormal myocardial perfusion before transplantation in patients with malignant hematologic diseases can aid in predicting the mid-to-long-term mortality risk after transplantation.
