Value of early rest myocardial perfusion imaging with SPECT in patients with chest pain and non-diagnostic ECG in emergency department

The prognostic value of left ventricular diastolic dyssynchrony combined with myocardial perfusion, systolic dyssynchrony, and cardiovascular risk factors in patients with normal left ventricular ejection fraction

OBJECTIVE

Major adverse cardiovascular events (MACE) still occur in the normal left ventricular ejection fraction (LVEF) patients with coronary artery disease (CAD). Currently, there are no studies related to the prognostic value of left ventricular diastolic dyssynchrony (LVDD) in combination with perfusion, systolic dyssynchrony, and cardiovascular risk factors in patients with normal LVEF. Therefore, we aimed to investigate the incremental prognostic value of LVDD in patients with normal LVEF and to establish a model to predict MACE.

METHODS

This study included 239 suspected or known CAD patients with a normal LVEF who underwent gated single-photon emission computerized tomography myocardial perfusion imaging. Clinical data such as age, sex, and cardiovascular risk factors were collected. Myocardial perfusion, and left ventricular dyssynchrony parameters were assessed using QPS and Emory Toolbox software, respectively. The least absolute shrinkage and selection operator and multivariable Cox regression were used to select the variables.

RESULTS

The subjects were followed up for a total of 73.2 ± 16.4 months and MACE occurred in 28 patients. In multivariate Cox regression, rest diastolic bandwidth (BW) was closely related to MACE [hazard ratio (95% confidence interval), 10.78 (1.65-70.35); P  = 0.013]. The C-index of the model was increased from 0.748 to 0.783 by increasing the rest diastolic BW on the basis of summed difference score (SDS), stress systolic SD, age, hypertension, and chest pain ( P  < 0.001). A final model for predicting MACE was constructed based on age, hypertension, chest pain, SDS, stress systolic SD, and rest diastolic BW. The C-index of the model was 0.783, and the area under the curves of the model predicting the occurrence of 3-year and 5-year MACE events were 0.766 and 0.827, respectively. The calibration curve showed a good calibration of the model.

CONCLUSION

LVDD is associated with MACE in patients with normal LVEF. In addition, based on SDS, stress systolic SD, age, hypertension, and chest pain, rest diastolic BW had an incremental predictive value for MACE.

The application of mass defect percentage in the evaluation of acute coronary syndrome

OBJECTIVES

White blood cells, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio (NLR) distribution patterns in patients with anatomic coronary disease have previously been associated with cardiac events such as myocardial infarct size, complications, and prognosis. However, it remains unknown whether myocardial perfusion mass defect percentage (MDP) obtained from gated myocardial perfusion imaging (G-MPI) correlates with these hematological parameters. Therefore, our research aimed to investigate the application of MDP in the evaluation of acute coronary syndrome (ACS).

METHODS

Thirty-six patients with ACS underwent single-photon emission computed tomography/computed tomography using retrospective electrocardiography gating during the resting state. The primary outcome was the percentage of left ventricular mass with abnormal myocardial perfusion (i.e. MDP) in G-MPI. Furthermore, the correlation between myocardial perfusion MDP and lymphocyte count, neutrophil count, white blood cell count, and NLR was calculated. In addition, we explored the relationship of myocardial perfusion MDP with other cardiac function parameters obtained from G-MPI, such as summed rest score, left ventricular ejection fraction, end-systolic volume, and end-diastolic volume.

RESULTS

Myocardial perfusion MDP significantly correlated with white blood cell count, neutrophil count, and NLR ( P  < 0.01). Furthermore, these hematological parameters were significantly different between low and high MDP groups. Additionally, myocardial perfusion MDP negatively correlated with end-systolic volume ( r  = -0.615) and left ventricular ejection fraction ( r  = -0.657).

CONCLUSION

Myocardial perfusion MDP has a high correlation with inflammatory cell counts and cardiac function parameters obtained from G-MPI in ACS; this may be of help in the evaluation and treatment of these patients.

Severe stress cardiomyopathy following spinal corrective surgery for scoliosis complicated with pectus excavatum: a case report

BACKGROUND

Stress cardiomyopathy (SCM) is an acute heart failure syndrome characterized by transient, usually reversible left ventricular systolic dysfunction with normal or enhanced basal compensatory wall motion abnormalities involving the left ventricular anterior septum and apex, resulting in a "ballooning" appearance. However, it has rarely been reported in patients undergoing spinal surgery.

CASE PRESENTATION

We report a case of severe stress cardiomyopathy in a scoliosis patient with pectus excavatum who underwent spinal corrective surgery. During the wake-up period, circulatory collapse occurred. After multidisciplinary consultation, the patient was diagnosed with stress cardiomyopathy. At last, she had a good prognosis after a series of treatments including ECMO.

CONCLUSION

Stress cardiomyopathy is a reversible but uncommon condition. It can cause death if it is not diagnosed in time. Consequently, this report should improve the awareness of orthopedists and anesthesiologists for timely identification and management. For patients with potential risk factors, timely preoperative intervention should be performed to reduce the occurrence of stress cardiomyopathy.

Prognostic Value of Resting Left Ventricular Sphericity Indexes in Coronary Artery Disease With Preserved Ejection Fraction

BACKGROUND

Adverse left ventricular remodeling is a significant cardiovascular predictor for patients with coronary artery disease and preserved left ventricular ejection fraction (LVEF). However, the remodeling indexes reflecting left ventricular spherization by myocardial perfusion imaging are underexplored.

METHODS AND RESULTS

727 patients (mean age 59.8±13.5 years, 329 women) diagnosed or suspected coronary artery disease with preserved LVEF who underwent resting myocardial perfusion imaging were retrospectively enrolled. The myocardial perfusion imaging findings including the total perfusion deficit and sphericity indexes (shape index (SI) and eccentricity index (EI) obtained from gated (QGS) and non-gated (QPS) images) were collected. Major adverse cardiovascular events (MACE) were followed up for 45.1±22.0 months. All patients were divided into 4 subgroups based on total perfusion deficit at 10% and LVEF at 65%. Univariable comparative analyses were performed in 5 cohorts (all patients and 4 subgroups). Patients who experienced MACE displayed higher SI and/or lower EI (all P<0.05). Kaplan-Meier survival analyses suggested significant differences for SIQPS in all 5 cohorts, for EIQPS and EIQGS in 4 cohorts, and for end-systolic and end-diastolic SIQGS in 3 cohorts (all P<0.05). Multivariate Cox analysis showed that abnormal SI and EI remained statistically significant predictors for MACE after adjusting for total perfusion deficit, LVEF, and other confounding factors.

CONCLUSIONS

For patients diagnosed or suspected of coronary artery disease with preserved or supra-normal LVEF, resting sphericity indexes by myocardial perfusion imaging displayed incremental long-term prognostic value. Among these indicators, SIQPS is particularly promising across different perfusion or preserved functional conditions.

Predictive value of incidental right ventricular abnormalities identified on SPECT for mortality and pulmonary hypertension

BACKGROUND

The clinical significance of incidentally found RV abnormalities on low-risk SPECT studies is not well-defined. The objective of this study was to determine the predictive value of incidental right ventricular (RV) abnormalities identified on single photon emission computed tomography (SPECT) scans for mortality and pulmonary hypertension (PH).

METHODS

We retrospectively analyzed all low-risk SPECT studies in patients without known coronary artery or pulmonary vascular disease, performed at our institution, from 2007-2020. Adjusted Cox proportional hazards models were used to evaluate the association between incidental RV abnormalities on low-risk SPECT studies and outcomes.

RESULTS

Of the 4761 patients included in the analysis, mortality events were present in 494, and echocardiographic PH was present in 619. Incidental RV abnormalities on low-risk SPECT studies were significantly and independently associated with all-cause mortality (HR = 1.41, CI [1.07-1.86], P = 0.0152) and echocardiographic PH (HR = 2.06, CI [1.64-2.60], P < 0.0001).

CONCLUSIONS

These data suggest incidental RV abnormalities found on low-risk SPECT imaging studies are significantly and independently associated with increased mortality and risk of developing echocardiographic PH, and could identify high-risk patients for closer monitoring and additional diagnostic testing.

A model combining rest-only ECG-gated SPECT myocardial perfusion imaging and cardiovascular risk factors can effectively predict obstructive coronary artery disease

Objective

The rest-only single photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had low sensitivity in diagnosing obstructive coronary artery disease (CAD). Improving the efficacy of resting MPI in diagnosing CAD has important clinical significance for patients with contraindications to stress. The purpose of this study was to develop and validate a model predicting obstructive CAD in suspected CAD patients, based on rest-only MPI and cardiovascular risk factors.

Methods

A consecutive retrospective cohort of 260 suspected CAD patients who underwent rest-only gated SPECT MPI and coronary angiography was constructed. All enrolled patients had stress MPI contraindications. Clinical data such as age and gender were collected. Automated quantitative analysis software QPS and QGS were used to evaluate myocardial perfusion and function parameters. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to select the variables and build the prediction model.

Results

Among the enrolled 260 patients with suspected CAD, there were 95 (36.5%, 95/260) patients with obstructive CAD. The prediction model was presented in the form of a nomogram and developed based on selected predictors, including age, sex, SRS ≥ 4, SMS ≥ 2, STS ≥ 2, hypertension, diabetes, and hyperlipidemia. The AUC of the prediction model was 0.795 (95% CI: 0.741–0.843), which was better than the traditional models. The AUC calculated by enhanced bootstrapping validation (500 bootstrap resamples) was 0.785. Subsequently, the calibration curve (intercept = − 0.106; slope = 0.843) showed a good calibration of the model. The decision curve analysis (DCA) shows that the constructed clinical prediction model had good clinical applications.

Conclusions

In patients with suspected CAD and contraindications to stress MPI, a prediction model based on rest-only ECG-gated SPECT MPI and cardiovascular risk factors have been developed and validated to predict obstructive CAD effectively.

Incremental value of regional wall motion abnormalities for detecting obstructive coronary artery disease by rest-only electrocardiogram-gated single-photon emission computerized tomography myocardial perfusion imaging in suspected coronary artery disease patients

OBJECTIVE

The purpose of this study was to determine whether regional wall motion (WM) abnormalities by rest-only 99mtechnetium-sestamibi (99mTc-MIBI) electrocardiogram (ECG)-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) had incremental diagnostic value for detecting obstructive coronary artery disease (CAD) in suspected CAD patients.

METHODS

This study retrospectively studied 255 consecutive suspected CAD patients who underwent rest-only ECG-gated SPECT MPI and were performed coronary angiography within 3 months. Obstructive CAD was defined as ≥70% narrowing of the inner diameter of the left anterior descending coronary artery, left circumflex coronary artery and right coronary artery or their main branches and ≥50% narrowing of the left main coronary artery. QPS and QGS were used to assess rest perfusion and WM. Summed rest score ≥4 and summed motion score ≥2 exhibited in two consecutive segments in one territory was considered abnormal.

RESULTS

The sensitivity of the combination of perfusion and regional WM abnormalities was significantly higher than perfusion alone for detecting obstructive CAD (46.8% vs. 30.9%; P < 0.001), with similar specificity (91.9% vs. 95.0; P = 0.063). The global chi-square value of combination of perfusion and WM increased from 31.40 to 50.71 (P < 0.001) compared to perfusion. The sensitivity of combination of perfusion and WM for detecting obstructive CAD in patients with multivessel disease was higher than single-vessel disease (56.1% vs. 25.0%; P < 0.001), with similar specificity.

CONCLUSION

Regional WM abnormalities at rest, as shown by rest-only 99mTc-MIBI ECG-gated SPECT MPI, have additional diagnostic value over perfusion alone for detecting obstructive CAD in suspected CAD patients.