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Seeing beyond perfusion - is there a role for other high-risk ischemia markers in patients with normal perfusion on SPECT Myocardial Perfusion Imaging?
Session:
Posters (Sessão 6 - Écran 1) - Imagem 3 - RM Cardíaca e Cardiologia Nuclear
Speaker:
Paulo Medeiros
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Paulo Medeiros; Bárbara Pereira; Paula Soeiro; Jorge Rodrigues; Victor Alves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">INTRODUCTION: Single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is a useful non-invasive test for the diagnosis of obstructive coronary artery disease (CAD). The incidence of significant CAD in patients with normal perfusion studies is <1%/year. Other high-risk markers include decrease of left ventricle ejection fraction (LVEF) on stress study compared to rest or transient ischemic dilation (TID), but the impact of these markers in patients with normal perfusion is unknown.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AIM: To evaluate the incidence of significant CAD in patients with high-risk markers of ischemia despite a normal perfusion study.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: Single-center, observational, retrospective, and longitudinal study. Inclusion criteria were age ≥18 years, availability of both rest and stress SPECT-MPI studies, normal perfusion (defined by visual assessment and as a Summed Stress Score (SSS) < 4) and gated-study for LVEF and volume analysis. Exclusion criteria were known CAD, non-ischemic cardiomyopathy, and congenital heart disease. Defined high-risk markers: LVEF reduction ≥5% on stress vs. rest study; TID (defined as a stress/rest volume ratio ≥ 1.15. Primary endpoint was the identification of significant CAD (stenosis >70% on an epicardial coronary artery or >50% on the left main artery) on invasive coronary angiography. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: A total of 197 patients met the inclusion criteria. Mean age was 63.4 years and 40.6% (n=80) of patients were male. Regarding background, 75.6% of patients had hypertension, 54.3% dyslipidemia, 26.9% diabetes mellitus, 14.2% chronic kidney disease. Twenty-six percent of patients had a LVEF reduction > 5% on stress study; 24.9% had a stress/rest end-systolic volume ratio >1.15; 7.1% had a stress/rest mean volume ratio > 1.15; 7.1% had a stress/rest end-diastolic volume ratio > 1.15. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Time-to-primary endpoint was significantly lower in patients with LVEF reduction > 5% on stress (67.99 vs. 77.56 months, 95% CI: 60.49-75.49; p=0.003) and on patients with stress/rest end-systolic volume ratio > 1.15 (68.39 vs. 77.3 months, 95% CI: 60.69-76.10; p=0.013). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: In patients with normal perfusion on SPECT-MPI, the incidence of significant CAD was significantly higher in those with LVEF reduction ≥ 5% on stress study and in those with a stress/rest end-systolic volume ratio ≥ 1.15. These markers may be of clinical relevance in the follow-up of patients with suspected CAD.</span></span></p>
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