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Purpose <p>This study aimed to investigate the prognostic value of multi-dimensional parameters derived from D-SPECT in patients with ANOCA, and to identify feasible imaging markers for individualized risk stratification and therapeutic decision-making.</p> Methods <p>A total of 177 ANOCA patients were included. Myocardial blood flow (MBF) was quantified globally and in three vascular territories (LAD, LCX, RCA) under rest and regadenoson-induced stress conditions. Myocardial flow reserve (MFR) was calculated globally and regionally. Other parameters included MPI findings, systolic and diastolic function, phase analysis, total perfusion defect (TPD), and transient ischemic dilation (TID). The occurrence of major adverse cardiac events (MACE) was recorded. Cox regression was used to indentify predictors of MACE. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values. Survival curves were generated using the Kaplan-Meier method. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the incremental prognostic value of global MFR and MFR-LAD. Subgroup analyses stratifying patients with entirely normal coronary arteries from those with non-obstructive epicardial atherosclerosis were performed.</p> Results <p>During a median follow-up of 22 months (IQR 18–24 months), 23 MACE occurred in the overall cohort (23/177, 13.0%). The MACE group had a significantly higher prevalence of abnormal MPI compared to the non-MACE group (26.1% [6/23] vs. 5.8% [9/154], <i>P</i> = 0.001). Global MFR and territorial (LAD, LCX, RCA) MFR were significantly decreased in the MACE group. In multivariate Cox regression models, abnormal MPI (model 1 (Per-patient): HR = 4.223; 95% CI 1.658–10.756; <i>P</i> = 0.003; model 2 (Per-vessel): HR = 4.445; 95% CI 1.720–11.490; <i>P</i> = 0.002), global MFR (HR = 0.534; 95% CI 0.336–0.847; <i>P</i> = 0.008), and MFR-LAD (HR = 0.338; 95% CI 0.136–0.839; <i>P</i> = 0.019) were independent predictors of MACE. The optimal cut-off values were &lt; 2.78 for global MFR and &lt; 2.52 for MFR-LAD. Compared with MPI alone, the addition of global MFR and MFR-LAD provided incremental prognostic benefit (NRI 0.682–0.769; IDI 0.052–0.063). Subgroup analyses revealed no significant interaction between atherosclerosis and abnormal MPI or MFR.</p> Conclusion <p>D-SPECT-derived multiparameters provide incremental prognostic information in ANOCA patients beyond conventional MPI. Patients with abnormal MPI, decreased global MFR, or decreased MFR-LAD are at higher risk of MACE. Combining global and regional MFR effectively facilitates risk stratification for early prevention and intervention.</p>

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The prognostic value of multiparameters derived from D-SPECT in patients with ANOCA

  • 期刊论文

  • 发表日期：

    2026年2月19日

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  • Rong Wang,
  • Wei Dong,
  • Haijun Wang,
  • Juan Wang,
  • Chouchou Fan,
  • Yubo Liang,
  • Jing Chen,
  • Lizhen Yang,
  • Xiaoling Zong,
  • Ping Xie

摘要

Purpose

This study aimed to investigate the prognostic value of multi-dimensional parameters derived from D-SPECT in patients with ANOCA, and to identify feasible imaging markers for individualized risk stratification and therapeutic decision-making.

Methods

A total of 177 ANOCA patients were included. Myocardial blood flow (MBF) was quantified globally and in three vascular territories (LAD, LCX, RCA) under rest and regadenoson-induced stress conditions. Myocardial flow reserve (MFR) was calculated globally and regionally. Other parameters included MPI findings, systolic and diastolic function, phase analysis, total perfusion defect (TPD), and transient ischemic dilation (TID). The occurrence of major adverse cardiac events (MACE) was recorded. Cox regression was used to indentify predictors of MACE. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values. Survival curves were generated using the Kaplan-Meier method. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the incremental prognostic value of global MFR and MFR-LAD. Subgroup analyses stratifying patients with entirely normal coronary arteries from those with non-obstructive epicardial atherosclerosis were performed.

Results

During a median follow-up of 22 months (IQR 18–24 months), 23 MACE occurred in the overall cohort (23/177, 13.0%). The MACE group had a significantly higher prevalence of abnormal MPI compared to the non-MACE group (26.1% [6/23] vs. 5.8% [9/154], P = 0.001). Global MFR and territorial (LAD, LCX, RCA) MFR were significantly decreased in the MACE group. In multivariate Cox regression models, abnormal MPI (model 1 (Per-patient): HR = 4.223; 95% CI 1.658–10.756; P = 0.003; model 2 (Per-vessel): HR = 4.445; 95% CI 1.720–11.490; P = 0.002), global MFR (HR = 0.534; 95% CI 0.336–0.847; P = 0.008), and MFR-LAD (HR = 0.338; 95% CI 0.136–0.839; P = 0.019) were independent predictors of MACE. The optimal cut-off values were < 2.78 for global MFR and < 2.52 for MFR-LAD. Compared with MPI alone, the addition of global MFR and MFR-LAD provided incremental prognostic benefit (NRI 0.682–0.769; IDI 0.052–0.063). Subgroup analyses revealed no significant interaction between atherosclerosis and abnormal MPI or MFR.

Conclusion

D-SPECT-derived multiparameters provide incremental prognostic information in ANOCA patients beyond conventional MPI. Patients with abnormal MPI, decreased global MFR, or decreased MFR-LAD are at higher risk of MACE. Combining global and regional MFR effectively facilitates risk stratification for early prevention and intervention.