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

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

doi:10.1007/s12350-022-03038-w

Cited by 10 publications

(8 citation statements)

References 45 publications

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“…In this study, we expanded on previous meta-analysis [10,11] by including more recent studies [18,19,25,26,[31][32][33][34][35][36][37][38][39][40]. We have expanded our study population to include a greater number of Asian populations, such as those from China and Japan.…”

Section: Discussionmentioning

confidence: 99%

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Luo,

Liu,

Liu

et al. 2023

Cardiology

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Introduction: The main aim of this study was to investigate the impact of isolated coronary microvascular disease (CMD) as diagnosed via various modalities on prognosis. Methods: A systematic literature review of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to March 2023. Included studies were required to measure coronary microvascular function and report outcomes in patients without obstructive coronary artery disease (CAD) or any other cardiac pathological characteristics. The primary endpoint was all-cause mortality, and the secondary endpoint was a major adverse cardiac event (MACE). Pooled effects were calculated using random effects models. Results: A total of 27 studies comprising 18,204 subjects were included in the meta-analysis. Indices of coronary microvascular function measurement included coronary angiography-derived index of microcirculatory resistance (caIMR), hyperemic microcirculatory resistance (HMR), coronary flow reserve (CFR), and so on. Patients with isolated CMD exhibited a significantly higher risk of mortality (OR: 2.97, 95% CI, 1.91–4.60, p < 0.0001; HR: 3.38, 95% CI, 1.77–6.47, p = 0.0002) and MACE (OR: 5.82, 95% CI, 3.65–9.29, p < 0.00001; HR: 4.01, 95% CI, 2.59–6.20, p < 0.00001) compared to those without CMD. Subgroup analysis by measurement modality demonstrated consistent and robust pooled effect estimates in various subgroups. Conclusion: CMD is significantly associated with an elevated risk of mortality and MACE in patients without obstructive CAD or any other identifiable cardiac pathologies. The utilization of various measurement techniques may have potential advantages in the management of isolated CMD.

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Section: Discussionmentioning

confidence: 99%

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Luo,

Liu,

Liu

et al. 2023

Cardiology

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“…The diagnosis of heart failure was confirmed following the established criteria ( 24 ). Stroke was identified as an ischemic cerebral infarction induced by a thrombotic or embolic occlusion of any major intracranial artery ( 25 ).…”

Section: Methodsmentioning

confidence: 99%

Epicardial fat volume, an independent risk factor for major adverse cardiovascular events, had an incremental prognostic value to myocardial perfusion imaging in Chinese populations with suspected or known coronary artery disease with a normal left ventricular ejection fraction

Yang,

Yu,

Wan

et al. 2023

Front. Cardiovasc. Med.

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BackgroundMost coronary artery disease (CAD) patients with a normal left ventricular ejection fraction (LVEF) experience a poor prognosis. Single-photon emission computerized tomography (SPECT)–myocardial perfusion imaging (MPI), a routine examination, is useful in assessing risk and predicting major adverse cardiovascular events (MACEs) in populations with suspected or known CAD. SPECT/CT is a “one-stop shop” examination, which, through non-contrast CT, can produce attenuation correction for MPI and obtain information on coronary artery calcium (CAC) and epicardial fat volume (EFV) simultaneously. This study aims to investigate the predictive and incremental value of EFV to MPI for MACE in Chinese populations with suspected or known CAD with a normal LVEF.Methods and resultsWe retrospectively studied 290 suspected or known CAD inpatients with a normal LVEF who underwent SPECT/CT between February 2014 and December 2017. Abnormal MPI was defined as a summed stress score ≥4 or summed difference score ≥2. EFV and CAC were calculated using non-contrast CT. The end date of follow-ups was in February 2022. The follow-up information was obtained from the clinical case notes of the patients or reviews of telephone calls. MACE was defined as cardiac death, late coronary revascularization ≥3 months after MPI, non-fatal myocardial infarction, angina-related rehospitalization, heart failure, and stroke. During the 76-month follow-up, the event rate was 32.0% (93/290). Univariate and multivariate Cox regression analyses concluded that high EFV (>108.3 cm3) [hazard ratio (HR): 3.3, 95% CI: 2.1–5.2, P < 0.000] and abnormal MPI (HR: 1.8, 95% CI: 1.1–2.8, P = 0.010) were independent risk factors for MACE. The event-free survival of patients with high EFV was significantly lower than that of the low EFV group (log-rank test P < 0.001). In the subgroup with normal MPI, high EFV was associated with reduced event-free survival (log-rank P < 0.01), with a higher annualized event rate (8.3% vs. 1.9%). Adding high EFV to MPI could predict MACEs more effectively, with a higher concordance index (0.56–0.69, P < 0.01), higher global chi square (7.2–41.4, P < 0.01), positive integrated discrimination improvement (0.10, P < 0.01), and net reclassification index (0.37, P < 0.01).ConclusionsIn Chinese populations with suspected or known CAD with normal LVEF, high EFV was an independent risk factor for MACE after adjusting for traditional risk factors, CAC and MPI. In subgroups with normal MPI, EFV could also improve risk stratification. Adding EFV to MPI had an incremental value for predicting MACE.

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“…Demographic data and clinical characteristics of patients are detailed in Table 1. [25][26][27][28][29][30][31][32][33][34][35][36] Study sample size ranged from 151 to 19,495 subjects. For two studies, 31,34 we reported the number of patients with available CZT data.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

Prognostic Value of Myocardial Perfusion Imaging by Cadmium Zinc Telluride Single-photon Emission Computed Tomography in Patients with Suspected or Known Coronary Artery Disease A Systematic Review and Meta-analysis

Acampa¹,

Assante²,

Zampella³

et al. 2023

Preprint

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Background?Aim of this study was to define the prognostic value of stress myocardial perfusion imaging by cadmium zinc telluride (CZT) single-photon emission computed tomography (SPECT) for prediction of adverse cardiovascular events in patients with known or suspected coronary artery disease (CAD). Methods and Results?Studies published until November 2022 were identified by database search. We included studies using stress myocardial perfusion imaging by CZT-SPECT to evaluate subjects with known or suspected CAD and providing primary data of adverse cardiovascular events. Total of 12 studies were finally included recruiting 36,415 patients. Pooled hazard ratio (HR) for the occurrence of adverse events was 2.17 (95% confidence interval, CI, 1.78-2.65) and heterogeneity was 66.1% (P=0.001). Five studies reported data on adjusted HR for the occurrence of adverse events. Pooled HR was 1.69 (95% CI, 1.44-1.98) and heterogeneity was 44.9% (P=0.123). Seven studies reported data on unadjusted HR for the occurrence of adverse events. Pooled HR was 2.72 (95% CI, 2.00-3.70). Nine studies reported data useful to calculate separately the incidence rate of adverse events in patients with abnormal and normal myocardial perfusion. Pooled incidence rate ratio was 2.38 (95% CI, 1.39-4.06) and heterogeneity was 84.6% (P<0.001). The funnel plot showed no evidence of asymmetry (P=0.517). At meta-regression analysis, we found an association between HR for adverse events and presence of angina symptoms and family history of CAD. Conclusions?Stress myocardial perfusion imaging by CZT-SPECT is a valuable noninvasive prognostic indicator for adverse cardiovascular events in patients with known or suspected CAD.

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

Cited by 10 publications

References 45 publications

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

Epicardial fat volume, an independent risk factor for major adverse cardiovascular events, had an incremental prognostic value to myocardial perfusion imaging in Chinese populations with suspected or known coronary artery disease with a normal left ventricular ejection fraction

Prognostic Value of Myocardial Perfusion Imaging by Cadmium Zinc Telluride Single-photon Emission Computed Tomography in Patients with Suspected or Known Coronary Artery Disease A Systematic Review and Meta-analysis

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