RT Journal Article SR Electronic T1 Incremental prognostic value of left ventricular ejection fraction reserve over angiography and traditional functional variables by gated SPECT myocardial perfusion imaging JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 242031 OP 242031 VO 65 IS supplement 2 A1 Zhang, Shuang A1 Meng, Jingjing A1 Yun, Mingkai A1 Zhou, Yihan A1 Lu, Yao A1 Zhang, Xiaoli YR 2024 UL http://jnm.snmjournals.org/content/65/supplement_2/242031.abstract AB 242031 Introduction: The objective of this study was to assess the prognostic value of left ventricular ejection fraction reserve (△LVEF) as assessed by gated single-photon emission computed tomography myocardial perfusion imaging (SPECT G-MPI) in patients with coronary artery disease (CAD), and to investigate its potential for risk stratification.Methods: A total of 346 patients (age 60.5 ± 10.0 years, 262 male) with CAD who performed SPECT G-MPI and coronary angiogram (CAG) were retrospectively enrolled and followed up for 33.0 ± 7.6 months. All patients were classified into two groups (LVEF > 0% and LVEF ≤ 0%) and further divided into two subgroups according to various levels of summed stress score (SSS), summed difference score (SDS), total perfusion defect (TPD), the extent of myocardial ischemia (%LV), LVEFRest and LVEFStress. Survival analyses were performed, and the primary endpoint was major adverse cardiac events (MACEs), a composite of all-cause death, myocardial infarction, coronary revascularization and hospitalization for unstable angina.Results: A total of 91 MACEs (26.3%) were observed. The incidence of MACEs was higher in patients with △LVEF ≤ 0% compared to those with △LVEF > 0% (P = 0.038). In subgroup analysis, the cumulative incidence of MACEs was significantly greater in patients with △LVEF ≤ 0% than in those with △LVEF > 0% within the SSS ≥ 4, TPD ≥ 10%/LV, LVEFRest ≤ 50% and LVEFStress < 60% subgroups (P < 0.05). Furthermore, the rate of MACEs tended to be lower with the increasing △LVEF in patients with LVEFRest ≤ 50% (P = 0.004), but a similar trend was not observed in patients with LVEFRest > 50% (P = 0.359). (Figure 1) Adding △LVEF ≤ 0% to traditional functional variables assessed by MPI and multi-vessel disease by CAG significantly improved the prediction of MACEs (P < 0.05). (Figure 2)Conclusions: Reduced LVEF reserve estimated by SPECT G-MPI served as an effective parameter for stratifying the risk of patients with CAD and could provide incremental prognostic value over angiography and traditional functional variables by SPECT G-MPI.