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Prognostic value of combined coronary angiography-derived IMR and myocardial perfusion imaging by CZT SPECT in INOCA

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A significant proportion of ischemia with non-obstructive coronary artery disease (INOCA) demonstrate coronary microvascular dysfunction (CMD), a condition associated with abnormal myocardial perfusion imaging (MPI) and adverse outcomes. Coronary angiography-derived index of microvascular resistance (caIMR) is a novel non-invasive technique to assess CMD. We aimed to investigate the prognostic value of combined caIMR and MPI by CZT SPECT in INOCA patients.

Methods

Consecutive 151 patients with chest pain and < 50% coronary stenosis who underwent coronary angiography and MPI within 3 months were enrolled. caIMR was calculated by computational pressure-flow dynamics. CMD was defined as caIMR ≥ 25. The endpoint was major adverse cardiac events (MACE: cardiovascular death, nonfatal myocardial infarction, revascularization, angina-related rehospitalization, heart failure, and stroke).

Results

Of all INOCA patients, CMD was present in 93 (61.6%) patients. The prevalence of abnormal MPI was significantly higher in CMD compared with non-CMD patients (40.9% vs 13.8%, P < .001). CMD showed a higher risk of MACE than non-CMD patients. Patients with both CMD and abnormal MPI had the worst prognosis, followed by patients with CMD and normal MPI (log-rank P < .001). Cox regression analysis identified CMD (HR 3.121, 95%CI 1.221-7.974, P = .017) and MPI (HR 2.704, 95%CI 1.030-7.099, P = .043) as predictive of MACE. The prognostic value of INOCA patients enhanced significantly by adding CMD and MPI to the model with clinical risk factors (AUC = 0.777 vs 0.686, P = .030).

Conclusion

caIMR-derived CMD is associated with increased risk of MACE among INOCA patients. Patients with abnormalities on both caIMR and MPI had the worse outcomes.

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Abbreviations

INOCA:

Ischemia with non-obstructive coronary artery disease

CMD:

Coronary microvascular dysfunction

caIMR:

Coronary angiography-derived index of microcirculatory resistance

MPI:

Myocardial perfusion imaging

CZT:

Cadmium zinc telluride

MACE:

Major adverse cardiac events

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Acknowledgments

Those who contributed to the work and meet the authorship criteria are listed as authors of the article. We also are indebted to the participants of this study.

Funding

This work was supported by Chinese National Natural Science Foundation (82170521), Shanghai Natural Science Foundation of China (21ZR1449500), Foundation of Shanghai Municipal Health Commission (202140263), the Fundamental Research Funds for Central Universities (NO.22120190211), Foundation of Chongming (CKY2021-21, CKY2020-29), and Clinical Research Plan of SHDC (SHDC2020CR4065).

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Authors and Affiliations

  1. Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China

    Lu Liu MD, Guoqing Yin MD, Wen Zhang MD, Abdul-Quddus Mohammed MD, Siling Xu MD, Xian Lv MD, Tingting Shi MD, Cailin Feng MD, Ayman A. Mohammed MD, Redhwan M. Mareai MD, Yawei Xu MD, PhD, Xuejing Yu MD, PhD, Fuad A. Abdu MD, PhD & Wenliang Che MD, PhD

  2. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China

    Neng Dai MD, PhD

  3. Department of Nuclear Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China

    Fei Yu MD, PhD

  4. Department of Cardiology, Shanghai Tenth People’s Hospital Chongming Branch, Tongji University School of Medicine, Shanghai, China

    Wenliang Che MD, PhD

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  1. Lu Liu MD
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Correspondence to Xuejing Yu MD, PhD, Fuad A. Abdu MD, PhD, Fei Yu MD, PhD or Wenliang Che MD, PhD.

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Liu, L., Dai, N., Yin, G. et al. Prognostic value of combined coronary angiography-derived IMR and myocardial perfusion imaging by CZT SPECT in INOCA. J. Nucl. Cardiol. 30, 684–701 (2023). https://doi.org/10.1007/s12350-022-03038-w

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