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
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 majo...
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1261215/full |
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| author | Le Yang Le Yang Le Yang Wenji Yu Wenji Yu Peng Wan JingWen Wang JingWen Wang Xiaoliang Shao Xiaoliang Shao Feifei Zhang Feifei Zhang Xiaoyu Yang Yongjun Chen Qi Li Qi Li Dan Jiang Dan Jiang Yufeng Wang Yufeng Wang Qi Jiang Qi Jiang Jianfeng Wang Jianfeng Wang Yuetao Wang Yuetao Wang |
| author_facet | Le Yang Le Yang Le Yang Wenji Yu Wenji Yu Peng Wan JingWen Wang JingWen Wang Xiaoliang Shao Xiaoliang Shao Feifei Zhang Feifei Zhang Xiaoyu Yang Yongjun Chen Qi Li Qi Li Dan Jiang Dan Jiang Yufeng Wang Yufeng Wang Qi Jiang Qi Jiang Jianfeng Wang Jianfeng Wang Yuetao Wang Yuetao Wang |
| author_sort | Le Yang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T20:21:19Z |
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| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-11T20:21:19Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b50ae29a74ae41e2af3a13095928dad02023-10-03T04:32:22ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-10-011010.3389/fcvm.2023.12612151261215Epicardial 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 fractionLe Yang0Le Yang1Le Yang2Wenji Yu3Wenji Yu4Peng Wan5JingWen Wang6JingWen Wang7Xiaoliang Shao8Xiaoliang Shao9Feifei Zhang10Feifei Zhang11Xiaoyu Yang12Yongjun Chen13Qi Li14Qi Li15Dan Jiang16Dan Jiang17Yufeng Wang18Yufeng Wang19Qi Jiang20Qi Jiang21Jianfeng Wang22Jianfeng Wang23Yuetao Wang24Yuetao Wang25Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The first afflicted hospital of Ningbo University, Ningbo, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaDepartment of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaDepartment of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, ChinaInstitute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, ChinaBackgroundMost 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.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1261215/fullEFVcoronary artery calciumnon-contrast CTmyocardial perfusion imagingmajor adverse cardiovascular events (MACEs) |
| spellingShingle | Le Yang Le Yang Le Yang Wenji Yu Wenji Yu Peng Wan JingWen Wang JingWen Wang Xiaoliang Shao Xiaoliang Shao Feifei Zhang Feifei Zhang Xiaoyu Yang Yongjun Chen Qi Li Qi Li Dan Jiang Dan Jiang Yufeng Wang Yufeng Wang Qi Jiang Qi Jiang Jianfeng Wang Jianfeng Wang Yuetao Wang Yuetao Wang 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 Frontiers in Cardiovascular Medicine EFV coronary artery calcium non-contrast CT myocardial perfusion imaging major adverse cardiovascular events (MACEs) |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | EFV coronary artery calcium non-contrast CT myocardial perfusion imaging major adverse cardiovascular events (MACEs) |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1261215/full |
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