Myocardial stress perfusion scintigraphy for outcome prediction in patients with severe left ventricular systolic...

Area of Science:

• Cardiology
• Nuclear Cardiology
• Cardiovascular Imaging

Background:

• Coronary angiography is recommended for suspected chronic coronary syndrome with left ventricular ejection fraction (LVEF) ≤35%.
• The predictive role of ischemia testing, such as stress-rest myocardial perfusion scintigraphy (MPS), for risk stratification in these patients is not well-defined.

Purpose of the Study:

• To evaluate the prognostic value of stress-rest myocardial perfusion scintigraphy (MPS) in patients with reduced left ventricular ejection fraction (LVEF).
• To assess the predictive capability of summed rest score (SRS) and summed stress score (SSS) for cardiovascular outcomes in patients stratified by LVEF.

Main Methods:

• 1576 patients undergoing MPS were retrospectively analyzed.
• Patients were categorized into three LVEF groups: ≤35%, 36-49%, and ≥50%.
• Cardiovascular death, non-fatal myocardial infarction (MI), all-cause death, and late revascularization were recorded as endpoints.

Main Results:

• Patients with LVEF ≤35% exhibited higher rates of cardiovascular events and mortality compared to other groups.
• Summed rest score (SRS), summed stress score (SSS), and summed difference score (SDS) showed limited predictive accuracy for major adverse cardiovascular events in the LVEF ≤35% subgroup.
• Despite lower predictive accuracy, SRS and SSS cut-offs retained independent prognostic significance in multivariable models including coronary artery disease severity and prior revascularization.

Conclusions:

• In patients with LVEF ≤35%, SRS and SSS are less predictive of outcomes compared to patients with better preserved systolic function.
• However, the prognostic information derived from SRS and SSS cut-offs remains significant and independent of coronary artery disease burden and early revascularization in this high-risk population.