The potential of dynamic 99mTc-sestamibi cadmium zinc telluride-single-photon emission computed tomography camera assessing myocardial flow reserve in patients with heart failure with preserved ejection fraction

Figures

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  Figure 1. Patient flow diagram. The medical records of 127 patients who underwent dynamic 99mTc-MIBI perfusion single-photon emission computed tomography using a D-single-photon emission computed tomography camera were retrospectively reviewed. Of these, 90 patients met the exclusion criteria and 1 was excluded because of inadequate examination. The resultant 36 patients were included in the current analysis.

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  Figure 2. Resting and stress myocardial blood flow (mL/g/min). (A) Resting myocardial blood flow: no significant difference. (B) Stress myocardial blood flow: mean ± SEM of non-heart failure with preserved ejection fraction (n = 22) and heart failure with preserved ejection fraction (n = 14) are 3.77 ± 0.19 and 2.84 ± 0.26, respectively. 95% Confidence interval is −1.56 to −0.28. P = 0.0059 (two-tailed unpaired t-test).

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  Figure 3. Myocardial flow reserve. Mean ± SEM of non-heart failure with preserved ejection fraction (n = 22) and heart failure with preserved ejection fraction (n = 14) are 2.74 ± 0.14 and 2.00 ± 0.097, respectively. 95% Confidence interval is −1.12 to −0.35. P = 0.0004 (two-tailed unpaired t-test).

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  Figure 4. Receiver operating characteristic carve for myocardial flow reserve. AUC, area under the curve, the cut-off value for myocardial flow reserve is 2.525.

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  Figure 5. Relationship between myocardial flow reserve and diastolic dysfunction score. Based on echocardiographic parameters, each case was classified into five grades: 0–4. The parameters used for scoring were average E/e′ > 14, septal e′ velocity <7 cm/s, TR systolic jet velocity >2.8 m/s and left atrial volume index >34 mL/m2. None of the patients in the non-heart failure with preserved ejection fraction group scored 4 points.

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  Figure 6. Kaplan–Meier survival analysis for patients with heart failure with preserved ejection fraction. The heart failure with preserved ejection fraction group (n = 14) was divided into two groups according to the median value of myocardial flow reserve (2.075): higher (n = 7) and lower (n = 7) groups. An event was defined as hospitalization due to heart failure or cardiovascular death. The dotted lines show 95% confidence intervals for each group. The log-rank (Mantel–Cox) test was applied to compare survival curves.