Mannarino, Teresa (2022) Regional myocardial perfusion evaluation by CZT SPECT imaging in predicting lesion-related outcome in patients with suspected or known CAD. [Tesi di dottorato]

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Abstract

Background. The aim of this study was to evaluate the prognostic value of regional myocardial perfusion assessed by CZT camera in predicting lesion-related outcome in patients with suspected or known coronary artery disease (CAD). Methods. 541 patients (431 men, 110 women, mean age 64±10 years) with suspected or known CAD were studied. All patients underwent single-day stress/rest CZT-SPECT and were referred to coronary angiography by a clinical physician within 90 days from SPECT. Total perfusion deficit (TPD), left ventricular volumes and ejection fraction were automatically calculated using a commercially available software. Ischemic TPD (ITPD) was defined as stress TPD-rest TPD. On coronary angiography, significant CAD was considered in presence of luminal diameter stenosis ≥50%. The outcome was a composite end point of cardiac death, target vessel-related myocardial infarction, or late coronary revascularization. Results. During a median follow-up of 27 months (range 7-56 months) 31 cardiac events occurred (6% cumulative event rate). Patients with events had similar clinical features and cardiovascular risk factors as compared to patients without events. However, a higher prevalence of significant CAD at coronary angiography was observed in patients with events (P<0.001). Patients with events had significantly higher values of stress TPD (P=0.04), ITPD (P<0.001) and left ventricular volumes (all P<0.05) as compared to patients without. At regional analysis, vessels with CAD ≥50% showed significantly higher regional stress TPD and ITPD (both P <0.001) as compared to vessels without CAD. Moreover, lesion-related events were observed in 39 (2%) vessels. Regional stress TPD and regional ITPD resulted significantly higher in vessels with lesion-related events as compared to those without (both P <0.001). At ROC analysis an ITPD value of 2% provided the best trade-off between sensitivity and specificity for identifying vessel-related event. At multivariable analysis, only the presence of CAD ≥50% and ITPD >2% resulted as independent predictors of events. Moreover, vessels with CAD <50% and ITPD >2% showed significantly higher annualized event rate as compared to those with ITPD <2% (P <0.05). The worst prognosis was observed in vessels with CAD >50% and ITPD >2% (log-rank P<0.001). Conclusions. Regional myocardial perfusion assessed by CZT camera demonstrated good reliability in predicting lesion-related events in patients with suspected or known CAD. In particular, an ITPD >2% showed high sensitivity and specificity in identifying high-risk vessels.

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