PT  - JOURNAL ARTICLE
AU  - Robert J.H. Miller
AU  - Tali Sharir
AU  - Yuka Otaki
AU  - Heidi Gransar
AU  - Joanna X. Liang
AU  - Andrew J. Einstein
AU  - Mathews B. Fish
AU  - Terrence D. Ruddy
AU  - Philipp A. Kaufmann
AU  - Albert J. Sinusas
AU  - Edward J. Miller
AU  - Timothy M. Bateman
AU  - Sharmila Dorbala
AU  - Marcelo Di Carli
AU  - Balaji K. Tamarappoo
AU  - Damini Dey
AU  - Daniel S. Berman
AU  - Piotr J. Slomka
TI  - Quantitation of Post-Stress Change in Ventricular Morphology Improves Risk Stratification
AID  - 10.2967/jnumed.120.260141
DP  - 2021 Mar 01
TA  - Journal of Nuclear Medicine
PG  - jnumed.120.260141
4099  - http://jnm.snmjournals.org/content/early/2021/03/12/jnumed.120.260141.short
4100  - http://jnm.snmjournals.org/content/early/2021/03/12/jnumed.120.260141.full
AB  - Shape index and eccentricity index are measures of left ventricular morphology. Although both measures can be quantified with any stress imaging modality, they are not routinely evaluated during clinical interpretation. We assessed their independent associations with major adverse cardiovascular events (MACE), including measures of post-stress change in shape index and eccentricity index. Methods: Patients undergoing single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) between 2009 and 2014 from the REFINE SPECT registry were studied. Shape index (ratio between the maximum LV diameter in short axis and ventricular length) and eccentricity index (calculated from orthogonal diameters in short axis and length) were calculated in end-diastole at stress and rest. Multivariable analysis was performed to assess independent associations with MACE (death, non-fatal myocardial infarction, unstable angina, or late revascularization). Results: In total, 14,016 patients, mean age 64.3 ± 12.2 and 8469 (60.4%) male, were included. MACE occurred in 2120 patients during a median follow-up of 4.3 years (interquartile range 3.4 – 5.7). Rest, stress, and post-stress change in shape and eccentricity indices were associated with MACE in unadjusted analyses (all p<0.001). However, in multivariable models only post-stress change in shape index (adjusted HR 1.38, p<0.001) and eccentricity index (adjusted HR 0.80, P = 0.033) remained associated with MACE. Conclusion: Two novel measures, post-stress change in shape index and eccentricity index, were independently associated with MACE and improved risk estimation. Changes in ventricular morphology have important prognostic utility and should be included in patient risk estimation following SPECT MPI.