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The Gustave Roussy immune score as a superior gatekeeper for predicting myocardial perfusion abnormalities and
1Department of Nuclear Medicine, Sivas Numune Hospital, Sivas, Turkey.
Objective:
Ischemic heart disease is driven by systemic immunonutritional disruptions rather than isolated epicardial stenoses. We investigated the diagnostic utility of the Gustave Roussy immune score (GRIS) and Naples prognostic score (NPS) in predicting ischemia, scar burden, and high-risk markers on myocardial perfusion imaging (MPI) in suspected stable coronary artery disease.
Methods:
This retrospective cohort included 325 patients (193 men; mean age, 60 years) undergoing ECG-gated single-photon emission computed tomography MPI. Patients were stratified into normal, ischemia, scar, and mixed groups. Routine blood parameters yielded the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), NPS, and GRIS.
Results:
Inflammatory indices (NLR, SII) and complex scores (NPS, GRIS) were significantly elevated in the ischemia and scar groups versus the normal perfusion group (P < 0.001). In multivariable analysis, GRIS - integrating cellular destruction and nutritional depletion with inflammation - was the strongest independent predictor of myocardial perfusion abnormalities (odds ratio: 10.57; 95% confidence interval: 5.11-21.89; P < 0.001), outperforming all other indices (area under the curve: 0.770; 86.3% specificity at >1 cutoff). Furthermore, elevated GRIS and NPS independently predicted poor prognosis (scar or reduced left ventricular ejection fraction) and transient ischemic dilation (>1.22) (P < 0.05).
Conclusion:
GRIS and NPS significantly outperform traditional inflammatory indices in detecting myocardial ischemia and cellular reserve depletion. Derived from routine blood tests, GRIS serves as a powerful clinical 'gatekeeper' before invasive procedures, effectively identifying patients with high biological frailty.