Predictive value of the proportion of hibernating myocardium in total perfusion defect on reversing remodeling in patients with ischemic cardiomyopathy and treated by revascularization

Objectives: To evaluate the predictive value of myocardial viability assessed by ^99mTc-MIBI gated myocardial perfusion imaging (GMPI) and ¹⁸F-FDG myocardial metabolism imaging PET/CT (GPET) on reverse left ventricle (LV) remodeling after revascularization in patients with ischemic cardiomyopathy (ICM).

Methods: 27 ICM patients (age 56.7±9.6y, 26 male) were prospectively recruited from a study population referred to the Anzhen Hospital of Capital Medical University from January 2016 to December 2019 for viability assessment with GMPI and GPET pre-revascularization. All patients performed follow-up GMPI and GPET at different stages (3~12 months) after revascularization. LV ejection fraction (LVEF, %), end-diastolic volume (EDV, mL) and end-systolic volume (ESV, mL) were obtained by QGS software. Total perfusion defect (TPD, %) and hibernating myocardium (HM, %LV) were analyzed by QPS software. EDV reduced at least 10% was defined as reverse LV remodeling. Then, patients were divided into two groups: Group1: reversed group (n =15) and Group2: non-reversed group (n=12). EDV, ESV, LVEF, HM, and HM/TPD (%/LV) were analyzed by t-tests. Binary logistic regression analysis was used to identify predictors for reverse LV remodeling. Receiver operating characteristic (ROC) curve analysis was performed and area under the curve (AUC) was calculated to assess the predictive power of HM/TPD for reverse LV remodeling. In addition, the correlation between the changes (Δ value: post-pre) of LV EDV and HM/TPD were analyzed.

Results: ΔEDV (-35.1 ± 24.9mL vs 20.1 ± 15.4mL, t = 6.712, P<0.01) and ΔESV (-39.3 ± 44.2 mL vs 11.3 ± 28.3 mL, t = 3.437, P<0.01) in Group2 were significantly higher than that in Group1. HM/TPD in Group2 was significantly lower than that in Group1 (0.6 ± 0.2% vs 0.4 ± 0.2%, t = -2.576, P<0.05). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of reverse LV remodeling (OR=71.17, 95%CI (1.6~3252.6),P<0.05). ROC curve showed that HM/TPD≥55%/LV could predict reverse LV remodeling after revascularization (AUC: 0.772, sensitivity: 80%, specificity:75%, P=0.017). A negative correlation between HM/TPD and ΔEDV was observed (r = -0.527, P < 0.01). Conclusions: The proportion of HM in total perfusion defect in patients with ICM was an independent predictor of reverse LV remodeling after revascularization. This finding warrants further prospective investigations. Acknowledgements: This project was sponsored by the National Natural Science Foundation of (81871377), Capital Characteristic Clinical Application Research (Z181100001718071).

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