The predictive value of left ventricular systolic synchrony based on gated myocardial perfusion imaging for major adverse cardiovascular events in elderly patients with coronary heart disease
Objective To investigate the value of left ventricular systolic synchrony assessed by gated myocardial perfusion imaging(GMPI)in predicting major adverse cardiovascular events(MACE)in elderly patients with coronary heart disease(CHD).Methods In this retrospective study,clinical data from elderly patients who had completed a two-day assessment of resting-loading GMPI between September 2012 and February 2014 in Beijing Hospital were collected,including the summed stress score(SSS)for total ischemic burden,measured by GMPI,left ventricular ejection fraction(LVEF),peak filling rate(PFR),phase band width(PBW),phase standard deviation(PSD)and phase entropy(PE).Follow-up of MACE was conducted.Independent risk factors for MACE were analyzed using a multifactorial Cox proportional hazards regression model,and the cumulative MACE incidence was analyzed using the Kaplan-Meier survival curve.Results A total of 427 subjects were enrolled,including 200(46.8％)men,with a mean age of 74.1±6.5(60-92)years and 323(75.6％)aged≥70 years.The median follow-up time was 54.7 months.At the end of follow-up,MACE occurred in 47 patients(11.0％).Compared with the group without MACE,the incidences of hypertension,hyperlipidemia,and hyperuricemia were significantly higher(x2=5.20,5.62,3.86,all P＜0.05),LVEF and PFR were significantly lower(t=-5.51,-5.23,both P＜0.001),and SSS,PSD,PBW,and PE were significantly higher(Z=4.78,t=5.14,5.78,5.62,all P＜0.001)in the MACE group.The results of Cox proportional hazards regression model analysis suggested that age ≥70(hazard ratio:2.57,95％CI:1.08-6.13),abnormal perfusion(hazard ratio:2.60,95％CI:1.31-5.15),increased PSD(hazard ratio:3.72,95％CI:1.72-8.05)and increased PE(hazard ratio:4.09,95％CI:1.94-8.63)were independent risk factors for the occurrence of MACE(all P＜0.05).Further analysis on 323 patients≥70 years indicated that abnormal perfusion(hazard ratio:2.96,95％CI:1.40-6.26),increased PSD(hazard ratio:3.51,95％CI:1.56-7.89),and increased PE(hazard ratio:4.49,95％CI:2.08-9.71)were independent risk factors for MACE(P＜0.05 for all).Conclusions Parameters of GMPI systolic synchrony analysis can very well identify the population at high risk of MACE in elderly patients with CHD.
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