Value Of Phase Analysis Of Gated Myocardial Perfusion Imaging In Assessing The Risk Stratification Of Stable Coronary Artery Disease

BackgroundAt present,the incidence of coronary artery disease in developing countries is on the rise and it is the most common cause of death in noncommunicable diseases.Stable coronary artery disease(SCAD)is the most common type of coronary artery disease.Its typical symptom is stable angina,it is generally characterized by episodes of reversible myocardial demand/supply mismatch,which are usually inducible by exercise or emotion,but,which may also be occurring spontaneously.Angina is caused by the release of ischaemic metabolites due to ischemia that stimulate sensitive nerve endings.Due to the differences in anatomy,function,and risk factors,there are may be significant individual differences in the prognosis of SCAD patients.Risk stratification is an important part of the management of SCAD patients.It can effectively reduce the incidence of major adverse cardiac events(MACE)for Long-term follow-up of low-risk patients,appropriate examination and active intervention in high-risk and intermediate-risk patients,while reducing the medical burden.Myocardial perfusion imaging(MPI)has been shown to be effective in assessing the risk of MACE in SCAD patients.With the development of gated technology,the application of gated myocardial perfusion imaging(GMPI)has become increasingly mature.As an objective,reproducible and non-invasive imaging method,GMPI can provide comprehensive quantitative and semi-quantitative parameters.It provides a multitude of information for the risk stratification of coronary artery disease and reference value for the formulation of treatment strategies.In addition,as chronic cardiovascular disease,GMPI plays an important role in long-term follow-up,reassessment of risk in SCAD patients.In the past,GMPI was used to stratify the risk of SCAD patients mainly through myocardial perfusion and left ventricular functions.Phase analysis as a technique for quantitative assessment of left ventricular systolic synchrony has not been applied to the risk stratification of SCAD.This study aims to explore that the application value of phase analysis in the risk stratification of SCAD.ObjectiveTo evalute the application value of phase analysis in the risk stratification of SCAD.Materials and Methods53 patients with SCAD admitted to our hospital for chest pain between March 2016 and March 2018 were collected,and 33 volunteers were included in the control group.All subjects underwent 2-days stress-rest GMPI.Quantitative gated SPECT(QGS)software was used to obtain perfusion abnormality percentage of rest and stress,left ventricular ejection fractions(LVEF)and phase analysis parameters including phase histogram bandwidth(BW)and standard deviation(SD).According to 《2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease》,patients were divided into high,intermediate and low risk groups by the risk stratification of SCAD using GMPI.Measured the phase analysis results of the above groups and compared the differences in phase parameters between groups.Results1.In rest GMPI,BW was statistically significant in the high,intermediate,low risk group,and in the control group(P < 0.05).SD was not statistically significant in the high-risk group and intermediate-risk group,intermediate-risk group and low-risk group(P = 0.109,0.063),and was statistically significant in the remaining groups(P < 0.05).2.In stress GMPI,BW was not statistically different between the low-risk group and the control group(P = 0.259),and there was a statistically significant difference among the other groups(P < 0.05).SD was not statistically significant in the high-risk and intermediate-risk group,low-risk group and the control group(P = 0.099,0.305).There was a statistically significant difference among the other groups(P<0.05).3.There was no statistical difference of BW and SD between rest and stress in all groups(P values were 0.101 to 0.398,0.272 to 0.950,respectively).Conclusion1.Phase analysis can be used to assess the global function of the heart through myocardial systolic synchrony,which contribute to the risk stratification of SCAD patients,especially for high-risk people;BW is more sensitive than SD.2.There is nearly same value of the phase analysis in stress and rest GMPI.By the phase analysis of rest GMPI,the intermediate-risk and high-risk populations can be screened out safely and inexpensively,avoiding the risk of stress test.