Electrocardiogram parameters in predicting reversible ischemia in myocardial perfusion SPECT: A case-control study
Seda Gülbahar Ateş1, Hüseyin Emre Tosun2, Gamze Tatar2
1Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Türkiye.
Insights
Electrocardiogram (ECG) repolarization parameters like Tp-Te/cQT ratio, QRS duration, and cQTd may predict reversible ischemia in myocardial perfusion SPECT scans for coronary artery disease (CAD) patients.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Myocardial perfusion SPECT and ECG are key for evaluating coronary artery disease (CAD).
- Understanding ventricular repolarization's link to ischemia is crucial for CAD assessment.
Purpose of the Study:
- To assess the relationship between ECG-derived ventricular repolarization parameters, including the index of cardiac electrophysiological balance (iCEB), and reversible ischemia detected by SPECT.
- To identify ECG predictors of reversible ischemia in patients with confirmed CAD.
Main Methods:
- Compared ECG parameters (QRS, QTd, cQTd, Tp-Te, Tp-Te/QT, Tp-Te/cQT, iCEB, iCEBc) in 45 patients with reversible ischemia on SPECT and 45 controls.
- Utilized 99m technetium-sestamibi (99mTc-MIBI) stress-rest SPECT and coronary angiography for diagnosis and assessment.
- Correlations were analyzed using Spearman test; predictors of reversible ischemia were identified via logistic regression.
Main Results:
- Patients with ischemia showed significantly longer QRS duration, cQTmax, QTd, and cQTd.
- The ischemia group had significantly lower Tp-Te, Tp-Te/QT, and Tp-Te/cQT ratios.
- Multivariate analysis identified hyperlipidemia, QRS duration, cQTd, and Tp-Te/QTc ratio as independent predictors of ischemia.
Conclusions:
- The Tp-Te/cQT ratio, QRS duration, and cQTd show potential as valuable predictors of reversible ischemia in SPECT.
- Further research is warranted to validate these ECG parameters for predicting reversible ischemia in CAD.
Background:
Myocardial perfusion single photon emission computed tomography (SPECT) and electrocardiogram(ECG) are crucial modalities in the evaluation of coronary artery disease(CAD) in clinical practice.
Objective:
To evaluate the relationship between ventricular repolarization parameters, index of cardiac electrophysiological balance (iCEB) from basal electrocardiograms (ECG), and reversible ischemia findings on SPECT.
Methods:
A total of 45 patients with reversible ischemia on 99m technetium-sestamibi (99mTc-MIBI) stress-rest myocardial perfusion SPECT and confirmed CAD by coronary angiography were included in the ischemia group. Forty-five patients with normal scans, matched by age and gender with the ischemia patient group, were included in the control group. The two-day 99mTc-MIBI SPECT protocol was performed with adenosine-pharmacologic stress. The presence of ischemia and reversible ischemia size (RIS) were recorded in the ischemia group. The summed stress scores (SSS) were recorded for the ischemia and control groups. The QRS, QTd, cQTd, Tp-Te, Tp-Te/QT, Tp-Te/cQT, iCEB (QT/QRS), and iCEBc (cQT/QRS) were calculated. Correlations between myocardial perfusion SPECT and ECG parameters were evaluated using the Spearman test. Predictors of reversible ischemia were assessed using logistic regression analysis.
Results:
The ischemia group showed significantly higher values for QRS duration (p = 0.018), cQTmax (p = 0.006), QTd (p = 0.002), and cQTd (p = 0.003). Tp-Te (p = 0.004), Tp-Te/QT ratio (p = 0.003), and Tp-Te/cQT ratio (p = 0.002) were significantly lower in the ischemia group. The multivariate analysis showed that hyperlipidemia, QRS duration, cQTd, and Tp-Te/QTc ratio were found as independent predictors of ischemia.
Conclusion:
The Tp-Te/cQT ratio, QRS duration, and cQTd might be valuable predictors of reversible ischemia in SPECT, warranting further study.
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