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Optimized gated a SPECT-derived myocardial salvage index: its prognostic significance in predicting major adverse cardiac events following acute myocardial infarction percussion

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Abstract

Purpose

Estimate myocardial salvage index (MSI) using a single-gated Single-Photon Emission Computed Tomography (SPECT) myocardial perfusion imaging (GSMPI) early after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and compare its predictive value with the traditional method especially for post-PCI left ventricular ejection fraction (LVEF) improvement and major adverse cardiac events (MACEs).

Methods

GSMPI was performed in 62 patients with AMI early after PCI (3–10 days). The MSI and the conventional parameters were obtained, including total perfusion deficit, LVEF, peak ejection rate (PER), and peak filling rate (PFR). The new calculation method (scoring evaluation method means the extent of abnormality is the percentage of the total scores of abnormal segments divided by the sum of the maximum scores of all myocardial segments using 4-point and 5-point scale semi-quantitative scoring method) and the reference method (number evaluation method means the extent of abnormality is the percentage of the number of abnormal segments divided by the total number of myocardial segments) were applied to acquire the MSI. We compared the predictive ability of the 2 methods based on the area under the receiver operating characteristic curve for LVEF improvement 6 months after PCI using MSI. The Kaplan–Meier method was used for depicting survival curves for predicting MACEs by the 2 methods. Cox proportional-hazards regression was applied to confirm the independent predictors of MACEs.

Results

The MSI obtained by the new method indicated stronger prognostic significance in LVEF improvement [area under the curve (AUC): 0.793, 95% confidence interval (CI) 0.620–0.912, P < .001] compared with the reference method (AUC: 0.634, 95%CI 0.452–0.792, P = .187). Delong’s test revealed a statistically significant difference in AUCs between the 2 methods (P < .05, 95%CI 0.003–0.316). The diagnostic value of the scoring evaluation method was higher than that of the number evaluation method. The Cox prevalence of MACEs was substantially higher in the < median MSI group than in the ≥ median MSI group (hazard ratio: 0.172; 95% CI 0.041–0.724; P < .05] using the new method, whereas no considerable differences were observed between the 2 groups using the reference method (P = .12). Further, the multivariate Cox regression analysis revealed that MSI was an independent indicator for predicting MACEs (P < .05).

Conclusion

The MSI obtained from a simple GSMPI early after PCI, using the scoring evaluation method, was a reliable prognostic indicator for predicting LVEF improvement and MACEs in AMI. It remarkably improved the prognostic value compared with the previous reference methods.

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Acknowledgements

I would like to thank my supervisor, Professor Xu, for his guidance through each stage of the process. I would like to acknowledge Professor Gao, for inspiring my interest in the development of innovative technologies. My research partner, Dr Dou, was instrumental in defining the path of my research. For this, I am extremely grateful. We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. There is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

Funding

This study was supported by the Key Project of Scientific and Technological Support Plan of Tianjin in 2020 (No. 20YFZCSY00820), the Key Disciplines of Tianjin Health Research Project (No. TJWJ2022XK032), and the Key Projects of Tianjin Natural Science Foundation (No. 22JCZDJC00130).

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Author notes

  1. Ting Li and Jing Dou Co-first author.

Authors and Affiliations

  1. Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, The Huan-Hu-Xi Road, Ti-Yuan-Bei, HeXi District, Tianjin, 300060, People’s Republic of China

    Ting Li & Wengui Xu

  2. Department of Nuclear Medicine, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People’s Republic of China

    Ting Li & Xuexiao Su

  3. Department of Cardiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People’s Republic of China

    Jing Dou, Yin Liu, Mingdong Gao & Jianyong Xiao

  4. Department of Radiology, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People’s Republic of China

    Hong Zhang

  5. Cardiovascular Institute, Tianjin Chest Hospital, No. 261 Tai Er Zhuang Road, Jinnan District, Tianjin, 300222, People’s Republic of China

    Jing Gao

  6. Thoracic Clinical College, Tianjin Medical University, No. 22 Qi Xiang Tai Road, Heping District, Tianjin, 300070, People’s Republic of China

    Jing Gao

  7. Graduate School, Tianjin Medical University, No. 22 Qi Xiang Tai Road, Heping District, Tianjin, 300070, People’s Republic of China

    Ting Li

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Li, T., Dou, J., Zhang, H. et al. Optimized gated a SPECT-derived myocardial salvage index: its prognostic significance in predicting major adverse cardiac events following acute myocardial infarction percussion. Ann Nucl Med 38, 219–230 (2024). https://doi.org/10.1007/s12149-023-01894-1

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