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Isolated apical perfusion defect in SPECT/CT scans – is there any prognostic value?
Session:
Painel 3 - Imagiologia Cardiovascular 5
Speaker:
João Gameiro
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Posters
FP Number:
---
Authors:
João Gameiro; Mauro Monteiro; Carolina Saleiro; Diana Decampos; Simone Costa; José Sousa; Luís Puga; Ana Rita M. Gomes; Joana M. Ribeiro; Joana Delgado Silva; Gracinda Costa; Lino Gonçalves
Abstract
<p><strong>Background</strong></p> <p>Myocardial perfusion imaging (MPI) plays a significant role in diagnostic and therapeutic decision making in coronary artery disease (CAD). An isolated apical defect in the 17<sup>th</sup> segment in SPECT/CT scans is a common finding, sometimes attributed to the apical thinning phenomenon. However, the clinical significance of apical thinning or other isolated apical defects is unknown.</p> <p><strong>Purpose</strong></p> <p>The purpose of this study is to assess the prognostic impact of an isolated apical perfusion defect (17<sup>th</sup> segment) in patients (P) with suspicion of significant CAD.</p> <p><strong>Methods</strong></p> <p>A cohort of 612 consecutive P that underwent a MPI test with a SPECT/CT scanner, between January 2017 and December 2017, in a single nuclear medicine centre, was included in this retrospective study.</p> <p>The inclusion criteria for this study were either a normal perfusion exam (group 1 – G1) or only an isolated apical defect in the 17<sup>th</sup> segment, either reversible suggesting ischemia (group 2 – G2) or fixed suggesting necrosis (group 3 – G3). Images with and without attenuation correction were analysed. Mean follow-up was 29 ± 4 months.</p> <p>The chi square test was used for categorical variables, and analysis of variance for continuous variables. Binary logistic regression was used to control for confounding.</p> <p><strong>Results</strong></p> <p>A total of 612 P were included (57% male sex, mean age of 69 ± 10) and divided in G1 (n = 494, 80.7%), G2 (n = 62, 10%) and G3 (n = 56, 9.2%). P in G3 had higher body mass index (31± 7, p = 0.028) and higher prevalence of dyslipidemia (84%, p = 0.001), while P in G1 had lower ejection fraction at rest (54 ±15, p = 0.001). There was no association between the presence of isolated apical defect and all- cause mortality (G1 = 7.3% vs G2 = 6.5% vs G3 = 5.4%, p= 0.851). There was a statistically significant difference between groups in the referral for coronary angiography in the bivariate analysis (G1 = 7.9% vs G2 = 35.5% vs G3 = 10.7%, p = 0.001), but this association did not remain when accounted for potential confounders (angina, ejection fraction, previous CAD and diabetes) – OR= 3.94, CI 95 [0,968 – 16,093], p = 0,056.</p> <p>In those P that underwent coronary angiography, there was no statistically significant difference between the 3 groups in revascularization of significant CAD (G1 = 38.5% vs G2 = 36.4% vs G3 = 50%, p = 0.830). During the follow-up time, 11 P of group 1 suffered an acute coronary syndrome (ACS), but there were no events in group 2 or 3.</p> <p><strong>Conclusion</strong></p> <p>Isolated apical myocardial defect on a SPECT/CT exam has no association with all-cause mortality in this patients. There is no significant difference in referral for coronary angiography or need for coronary revascularization between P with normal exams and P with isolated apical defects.</p>
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