The prognostic value of single photon emission computed tomography (SPECT) myocardial perfusion imaging is...

Area of Science:

• Cardiology
• Nuclear Cardiology
• Cardiac Imaging

Background:

• Myocardial perfusion imaging (MPI) accuracy can be influenced by various factors, with left ventricular (LV) size effects underexplored.
• Partial volume averaging in smaller hearts may obscure perfusion defects, potentially diminishing MPI's prognostic value.
• Understanding LV size impact is crucial for optimizing MPI interpretation and prognostic assessment.

Purpose of the Study:

• To investigate the influence of left ventricular size on the prognostic power of single photon emission computed tomography (SPECT) MPI.
• To determine if left ventricular end-diastolic volume affects the prediction of major adverse cardiac events (MACE) by stress total perfusion deficit (TPD).

Main Methods:

• SPECT MPI was performed on 2,503 patients without pathologically dilated LV.
• Stress total perfusion deficit (TPD) and rest end-diastolic volume (REDV) were quantified.
• Area under the curve (AUC) and Cox regression analyses assessed MACE prediction, stratified by sex and REDV tertile.

Main Results:

• Stress TPD demonstrated significant AUCs for MACE risk stratification across all sex and REDV tertiles (P<0.05).
• Increasing stress TPD, but not REDV, was independently associated with MACE in both men and women.
• No significant interaction between TPD and REDV was observed, indicating LV size did not modify TPD's prognostic impact.

Conclusions:

• The prognostic power of SPECT MPI, specifically stress TPD, is independent of left ventricular size.
• LV size does not appear to confound the prediction of MACE by SPECT MPI.
• These findings support the consistent utility of SPECT MPI for risk stratification across diverse patient populations.