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Microvascular dysfunction assessed by dynamic spect has a prognostic value in patients with a first acute myocardial
Andrew V Mochula1, Elena O Nalesnik2, Daria A Vorobyeva2
1Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia. mochula.andrew@gmail.com.
Insights
Dynamic single-photon emission computed tomography (SPECT) can predict major adverse cardiac events (MACE) in patients with acute myocardial infarction (AMI). Lower rest myocardial blood flow (MBF) measured by SPECT is a key indicator of long-term prognosis.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Acute myocardial infarction (AMI) requires accurate prognostication for patient management.
- Dynamic single-photon emission computed tomography (SPECT) is an advanced imaging technique.
Purpose of the Study:
- To assess the prognostic capability of dynamic SPECT in early acute myocardial infarction (AMI) patients.
- To identify imaging biomarkers for predicting major adverse cardiac events (MACE).
Main Methods:
- Sixty-three patients with first AMI underwent dynamic cadmium-zinc-telluride (CZT) SPECT 7-10 days post-infarction.
- Evaluated myocardial blood flow (MBF), myocardial flow reserve (MFR), and quantitative SPECT scores.
- Patients were followed for three years to record MACE.
Main Results:
- Lower rest MBF (≤0.39 mL/min/g) on dynamic SPECT predicted MACE with 70% sensitivity and 70% specificity.
- Rest MBF and Killip class were independent predictors of MACE.
- MACE+ patients had significantly lower rest MBF compared to MACE- patients.
Conclusions:
- Dynamic SPECT offers long-term prognostic value in early AMI.
- Rest MBF derived from dynamic SPECT is a promising predictor of MACE, especially when combined with clinical factors like Killip classification.
- Further multicenter studies are warranted to validate dynamic SPECT's role in AMI prognostication.
Aim:
To evaluate the prognostic value of dynamic single-photon emission computed tomography (SPECT) in patients with early acute myocardial infarction (AMI).
Methods:
Sixty-three patients with a first AMI were enrolled. Diagnostic and treatment algorithms were completed in full accordance with standard medical care. Dynamic cadmium-zinc-telluride (CZT) SPECT was performed 7-10 days after AMI. Stress and rest myocardial blood flow (MBF), myocardial flow reserve (MFR), summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were evaluated. Based on the occurrence of major adverse cardiac events (MACE) during a three-year follow-up, patients were divided into two groups: (1) MACE- (n = 53) and (2) MACE+ (n = 10).
Results:
Patients with MACE were characterized by a higher risk according to the GRACE Scale (p = 0.03) and a more severe condition by the Killip classification (p = 0.001). Dynamic SPECT revealed significantly lower rest MBF in the MACE + group compared to the MACE- group: 0.35 (0.32; 0.45) mL/min/g vs. 0.59 (0.32; 0.81) mL/min/g, respectively (p-value should be added here). Multivariable analysis demonstrated that rest MBF (OR 0.375; 95% CI: 0.15-0.95) and Killip class (OR 7.67; 95% CI: 1.65-35.54) were independent predictors of MACE in patients with a first acute myocardial infarction. A rest MBF value ≤ 0.39 mL/min/g predicted MACE within 3 years with a sensitivity of 70.0% and a specificity of 69.8%.
Conclusion:
Dynamic SPECT may have long-term prognostic value for patients with acute myocardial infarction. Rest MBF is a promising additional predictor of MACE when combined with Killip. Further research and multicenter studies are needed to confirm the role of dynamic SPECT.
Clinical Trial Registration:
none.
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