Prognostic Value of Phase Analysis for Predicting Adverse Cardiac Events Beyond Conventional Single-Photon Emission Computed Tomography Variables: Results From the REFINE SPECT Registry

Overview

Journal Circ Cardiovasc Imaging

Specialties Cardiology & Vascular Diseases
Radiology

Date 2021 Jul 20

PMID 34281372

Citations 11

Authors

Keiichiro Kuronuma

Robert J H Miller

Yuka Otaki

Serge D Van Kriekinge

Marcio A Diniz

Tali Sharir

Lien-Hsin Hu

Heidi Gransar

Joanna X Liang

Tejas Parekh

Paul B Kavanagh

Andrew J Einstein

Mathews B Fish

Terrence D Ruddy

Philipp A Kaufmann

Albert J Sinusas

Edward J Miller

Timothy M Bateman

Sharmila Dorbala

Marcelo Di Carli

Balaji K Tamarappoo

Damini Dey

Daniel S Berman

Piotr J Slomka

Affiliations

Soon will be listed here.

Abstract

Background: Phase analysis of single-photon emission computed tomography myocardial perfusion imaging provides dyssynchrony information which correlates well with assessments by echocardiography, but the independent prognostic significance is not well defined. This study assessed the independent prognostic value of single-photon emission computed tomography-myocardial perfusion imaging phase analysis in the largest multinational registry to date across all modalities.

Methods: From the REFINE SPECT (Registry of Fast Myocardial Perfusion Imaging With Next Generation SPECT), a total of 19 210 patients were included (mean age 63.8±12.0 years and 56% males). Poststress total perfusion deficit, left ventricular ejection fraction, and phase variables (phase entropy, bandwidth, and SD) were obtained automatically. Cox proportional hazards analyses were performed to assess associations with major adverse cardiac events (MACE).

Results: During a follow-up of 4.5±1.7 years, 2673 (13.9%) patients experienced MACE. Annualized MACE rates increased with phase variables and were ≈4-fold higher between the second and highest decile group for entropy (1.7% versus 6.7%). Optimal phase variable cutoff values stratified MACE risk in patients with normal and abnormal total perfusion deficit and left ventricular ejection fraction. Only entropy was independently associated with MACE. The addition of phase entropy significantly improved the discriminatory power for MACE prediction when added to the model with total perfusion deficit and left ventricular ejection fraction (<0.0001).

Conclusions: In a largest to date imaging study, widely representative, international cohort, phase variables were independently associated with MACE and improved risk stratification for MACE beyond the prediction by perfusion and left ventricular ejection fraction assessment alone. Phase analysis can be obtained fully automatically, without additional radiation exposure or cost to improve MACE risk prediction and, therefore, should be routinely reported for single-photon emission computed tomography-myocardial perfusion imaging studies.

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