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Prognostic value of myocardial flow reserve derived by quantitative SPECT for patients with intermediate coronary stenoses

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Functional assessment of myocardial ischemia is critical for patients with intermediate coronary stenosis. As the diagnosis performance of absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) by single-photon emission tomography (SPECT) has been proven, its prognostic value in patients with intermediate coronary stenosis remains to be evaluated.

Methods

Patients with one or more target lesions of ≥ 50% to ≤ 80% diameter stenoses on invasive coronary angiography were prospectively included in this study. All patients were scheduled for clinically indicated SPECT myocardial perfusion imaging (MPI) within 3 months and agreed to provide informed consent to participate in quantitative SPECT acquisitions to obtain MBF and MFR values. The primary endpoint was defined as a composite of the major adverse cardiac events (MACE): Cardiac death, myocardial infarction, late revascularization and heart failure or unstable angina-related rehospitalization.

Results

One hundred and nineteen patients (mean age 57 ± 8 years, 62.2% men) were included in the analysis. The average lumen stenosis of patients was 67.0 ± 10.4%. Over a median follow-up duration of 1408 days (interquartile range 1297-1666 days), 18 patients (15.1%) had MACE. Patients with impaired MFR (MFR < 2) had a significantly higher incidence of events than those with preserved MFR (MFR ≥ 2) in Kaplan-Meier survival analysis (Log-rank = 8.105, P = 0.004), while no significant difference was found between patients with normal relative perfusion and those with relative perfusion abnormalities (log-rank = 0.098, P > 0.05). In a multivariate Cox hazards analysis, the SPECT-derived MFR remained an independent predictor of MACE (HR 0.352, 95% CI 0.145-0.854, P = 0.021).

Conclusions

In a cohort of patients with angiographic intermediate coronary lesions, SPECT-derived MFR was an independent predictor of prognosis.

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Abbreviations

CAD:

Coronary artery disease

CI:

Confidence interval

FFR:

Fractional flow reserve

HR:

Hazard ratio

MACE:

Major adverse cardiac events

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

PET:

Position emission tomography

SPECT:

Single-photon emission computed tomography

SSS:

Summed stress score

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Authors and Affiliations

  1. Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China

    Ruoxi Sun MD, Rongzheng Ma MD, Meng Wang MD, Kai Han BS, Zongyao Zhang BS, Lei Wang MD & Wei Fang MD

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  1. Ruoxi Sun MD
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Correspondence to Lei Wang MD or Wei Fang MD.

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The work was supported by Beijing Municipal Science and Technology Plan Project Funding (Z191100006619017).

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Sun, R., Ma, R., Wang, M. et al. Prognostic value of myocardial flow reserve derived by quantitative SPECT for patients with intermediate coronary stenoses. J. Nucl. Cardiol. 30, 1427–1436 (2023). https://doi.org/10.1007/s12350-022-03186-z

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