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Published on: March 15, 2022
Spherization indices measured by resting SPECT improve risk stratification in patients with ischemia with
Yuting Zhao1,2, Yingqi Hu1,3, Yuanyuan Li1,3
1Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
Insights
Shape index (SI) and eccentricity index (E2) from myocardial perfusion imaging predict major adverse cardiac events (MACE) in ischemia with non-obstructive coronary artery disease (INOCA). The shape index (SI) showed superior predictive accuracy for MACE, improving risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Ischemia with non-obstructive coronary artery disease (INOCA) affects many patients, yet risk stratification remains challenging.
- Resting single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) offers insights into cardiac function, including spherical indices.
- The prognostic value of these spherical indices in INOCA patients requires further investigation.
Purpose of the Study:
- To assess the prognostic significance of spherical indices derived from resting SPECT MPI in patients diagnosed with INOCA.
- To determine if these indices can improve the prediction of major adverse cardiac events (MACE) in this population.
Main Methods:
- Retrospective analysis of resting SPECT MPI data in patients with INOCA.
- Evaluation of major adverse cardiac events (MACE) over a median follow-up period.
- Statistical analysis including survival analysis and multivariate Cox regression to assess the predictive value of shape index (SI) and eccentricity index (E2).
Main Results:
- A significant association was found between higher SI and lower E2 with increased MACE.
- Both abnormal SI and E2 independently predicted MACE in multivariate analysis.
- Incorporating SI into risk models significantly improved MACE prediction accuracy, while E2 did not.
Conclusions:
- Spherical indices, particularly the shape index (SI), are valuable for predicting long-term MACE in patients with INOCA.
- SI serves as a preferable indicator for risk stratification and prognostic assessment in INOCA patients.
- Resting SPECT MPI-derived spherical indices offer a promising tool for managing INOCA.
Background:
The prevalence of ischemia with non-obstructive coronary artery disease (INOCA) is substantial, but its risk stratification has been suboptimal. Resting SPECT myocardial perfusion imaging (MPI) could provide useful heart information including spherical indices. We aimed to evaluate the prognostic value of spherical indices in individuals with INOCA.
Results:
During a median follow-up of 47.2 ± 20.8 months, 49 (17.2%) patients experienced major adverse cardiac events (MACE). Compared to those without MACE, those with MACE had a higher shape index (SI) (0.60 ± 0.07 vs. 0.58 ± 0.06; P = 0.028) and a lower E2 (eccentricity index calculated by the QPS) (0.81 ± 0.05 vs. 0.83 ± 0.04; P = 0.019). MACE event-free survival analysis revealed significant differences in the SI and E2 among all patients (all log-rank P < 0.01). Multivariate Cox analysis showed abnormal SI (HR: 2.73, 95% CI 1.44-5.18, P = 0.002) and E2 (HR: 1.94, 95% CI 1.08-3.48, P = 0.026) were both independent predictors for MACE when they were put into the same model, respectively. The incorporation of the SI into the baseline model demonstrated a significant improvement in the predictive accuracy for MACEs (P = 0.026), whereas E2 did not exhibit a similar improvement (P > 0.05).
Conclusion:
For patients with INOCA, spherical indices (especially the SI) were associated with long-term MACE, which could be a preferable indicator for risk stratification and prognostic prediction.
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