The Gain Prognostic Value Of Left Ventricular Shape Index Obtained By SPECT GMPI In Patients With Reperfused Acute Myocardial Infarction

Objective:Left ventricular remodeling was a determinant of heart failure（HF）after acute myocardial infarction（AMI）and could manifest itself in changes in the size,shape,and function of the heart.The objective of this study was to explore the gain prognostic value of the left ventricular shape index（LVSI）obtained by^99mTc-MIBI SPECT gated myocardial perfusion imaging（GMPI）in patients with reperfused AMI.Methods:From January 2018 to January 2021,a total of 56 patients with reperfused AMI who underwent rest SPECT GMPI during one month were included retrospectively.According to the follow-up results whether HF occurred during one year,the patients were divided into positive and negative groups.Independent-samples t test,rank sum test,chi-square test were performed to compare whether there were differences in infarct size（IS）,left ventricular end diastolic volume（EDV）,left ventricular end systolic volume（ESV）,left ventricular ejection fraction（LVEF）,end diastolic shape index（EDSI）,end systolic shape index（ESSI）,hypertension,diabetes mellitus,hyperlipidemia,smoking history,alcohol consumption history,body mass index（BMI）,age and sex between the two groups;Spearman’s rank correlation coefficient to compare the correlation between EDSI,ESSI and EDV,ESV,LVEF;one-factor and multi-factor Logistic regression to analyze the predictors of HF and the ROC curve to obtain the best prognostic parameter.Results:1.A total of 56 patients were enrolled,including 28 in the positive group（males/females:22/6,average age of 61.68±11.60）and 28 in the negative group（males/females:20/8,average age of 56.36±10.42）.There were 21 cases（accounting for75.0%）of hypertension in the positive group and 13 cases（accounting for 46.4%）in the negative group,and the difference was statistically significant（P<0.05）.And there were no statistical difference in sex,age,BMI,smoking history,alcohol consumption history,hyperlipidemia,and diabetes mellitus between the two groups（all P>0.05）.2.The IS,EDV,ESV,EDSI and ESSI of the positive group were higher than those of the negative group,and the LVEF of the positive group was lower than that of the negative group,and all the differences were statistically significant（all P<0.05）.3.The EDSI and ESSI were highly positively relevant（r=0.871,P<0.001）.This indicated that the change of the left ventricular shape was highly consistent between the end-diastolic period and the end-systolic period.The ESSI and ESV were positively relevant（r=0.352,P=0.008）.The ESSI and LVEF were negatively relevant（r=-0.442,P=0.001）.These indicated that the larger the ESV,the larger the ESSI and the lower the LVEF.4.According to one-factor Logistic regression,the hypertension（OR=3.462,P=0.032）,IS（OR=1.084,P=0.012）,EDV（OR=1.022,P=0.020）,ESV（OR=1.031,P=0.007）,LVEF（OR=0.893,P=0.001）,EDSI（OR=8.280,P=0.001）and ESSI（OR=15.000,P=0.001）were predictors of HF.Incorporating the above parameters into multi-factor Logistic regression,it was found that IS（OR=1.100,P=0.047）,ESV（OR=1.038,P=0.012）,and ESSI（OR=17.189,P=0.003）were important predictors of HF.5.The area under the ROC curve（AUC）of ESSI was the largest（AUC=0.799）in the single parameter（EDSI,ESSI,EDV,ESV,LVEF）.The optimal threshold for predicting HF was 0.605（Sensitivity:53.6%,Specificity:92.9%）.The AUC of the combination of two or more parameters was higher than that of the single parameter,and the Sensitivity or Specificity of the optimal threshold for predicting HF were improved.Among them,the AUC of ESSI combined with EDV,ESV,and LVEF was the largest（AUC=0.898）,and the Sensitivity and Specificity of the optimal threshold for predicting HF were 71.4%and 100.0%,respectively.The AUC of ESSI combined with LVEF was slightly smaller（AUC=0.895）,the Sensitivity and Specificity of the optimal threshold for predicting HF were 78.6%and 89.3%,respectively.Conclusion:ESSI was an important predictor of HF in patients with reperfused AMI,which could identify left ventricular remodeling early.ESSI could improve the efficiency of predicting HF of EDV,ESV and LVEF,with gain value,which was better when combined with all the three parameters or LVEF.