Application of gated myocardial perfusion imaging in evaluating coronary heart disease-related heart failure with preserved ejection fraction

Background: This study evaluated the utility of single-photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in assessing heart failure with preserved ejection fraction (HFpEF) among patients with confirmed or suspected coronary artery disease (CAD). Methods: This retrospective study included consecutive patients with confirmed or suspected CAD who underwent SPECT GMPI. Patients were categorized into an HFpEF group ( n = 83) and a control group ( n = 43). HFpEF patients were further stratified by New York Heart Association (NYHA) functional class (Ⅰ, Ⅱ, and Ⅲ−Ⅳ). Analyzed GMPI parameters included left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), peak filling rate (PFR), mean filling rate during the first third of diastole (MFR/3), second peak filling rate (PFR2), time to peak filling (TTPF), summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS). Results: Multivariate logistic regression analysis identified adenosine triphosphate (ATP) stress-induced PFR (PFR -ATP ; odds ratio [OR]=0.1, 95% confidence interval [ CI ]: 0.004-0.7, P = 0.02) and SSS (OR = 1.6, 95% CI : 1.0-2.5, P = 0.03) as independent factors associated with HFpEF. Combining PFR -ATP with SSS showed superior discrimination for HFpEF compared to SSS alone (area under the curve [AUC]: 0.90 vs. 0.79, Z = 3.10, P = 0.002), but not when compared to PFR -ATP alone (AUC: 0.90 vs. 0.86, Z = 1.88, P = 0.06). PFR -ATP was significantly lower in the NYHA III-IV group than in the NYHA I group ( P = 0.001), while SSS was significantly higher in the NYHA II and III-IV groups than in the NYHA I group ( P = 0.005 and <0.001, respectively). SSS was negatively correlated with LVEF -ATP ( r = −0.48, P <0.001), PFR -ATP ( r = −0.36, P = 0.001), and MFR/3 -ATP ( r = −0.35, P = 0.001), and positively correlated with EDV -ATP ( r = 0.30, P = 0.005). Conclusion: SPECT GMPI may help evaluate HFpEF in patients with confirmed or suspected CAD, effectively assess cardiac function, and serve as a non-invasive tool for identifying the cause of myocardial ischemia and guiding personalized management of HFpEF.