Prognostic Value Of Peak Ejection Rate And Peak Filling Rate In Patients With Left Ventricular Systolic Dysfunction After Acute Myocardial Infraction

Objective:The patients with left ventricular systolic dysfunction?LVSD?after acute myocardial infraction?AMI?with revascularization always have poor prognosis.The aim of this study was to evaluate prognostic value of peak ejection rate?PER?and peak filling rate?PFR?in patients with LVSD after AMI with revascularization.Methods:1.We retrospectively analyzed 178 patients?140 males,38 females,age:59.7?11.0years?with LVSD[left ventricular ejection fraction?LVEF??40%]after AMI who underwent^99mTc-MIBI gated SPECT myocardial perfusion imaging?GSMPI?in First Hospital of Shanxi Medical University between January 2014 and December 2016.The parameters for evaluating myocardial perfusion defect of summed rest score?SRS?and total perfusion deficit?TPD?were gotten by quantitative perfusion SPECT?QPS?.The parameters for evaluating left ventricular function of LVEF,end diastolic volume?EDV?,end systolic volume?ESV?,PER,and PFR were gotten by quantitative gated SPECT?QGS?.2.The clinical parameters of 178 patients were recorded and taking cardiac events as the endpoint of follow-up[follow-up time:28?20,32?month].We defined heart failure,recurrent myocardial infarction,cardiac death and all-reason death as cardiac events.3.Pearson correlation was used to analyze the correlation between PER and PFR.Chi-square test and two independent t test were used to compare parameters between two groups after grouping according to results of follow-up.Receiver operating characteristic?ROC?curves were used to evaluate optimal cutoff of PER and PFR for predicting cardiac events.Kaplan-Meier survival curves were used to investigate the cumulative survival rate without cardiac events.Cox proportional hazards model was used for multivariate analysis.Results:1.There was a great correlation between PER and PFR?r=-0.964,P<0.001?.There were better correlation between PER,PFR and LVEF,EDV,ESV?r:PER:0.615,0.706,-0.733;PFR:-0.628,-0.706,0.681 all P<0.001?than between PER,PFR and heartrate,SRS,TPD?r:PER:-0.291,0.219,0.219;PFR:0.360,-0.217,-0.210 all P<0.05?.2.After follow-up,cardiac events occurred in 87?48.9%?of 178 patients.178patients were divided into two group of cardiac events-occurred?87 patients?and no cardiac events-occurred?91 patients?.There were no difference in gender,age,body mass index?BMI?,smoking,hypertension,diabetes,hyperlipidemia,coronary lesion count,SRS and TPD between two groups.The levels of EDV and ESV in group of cardiac events-occurred were higher than group of no cardiac events-occurred[EDV:136?122,166?vs 116?93,141?;ESV:100?79,127?vs 75?61,94?];the levels of heartrate,LVEF,-PER and PFR in group of cardiac events-occurred were lower than group of no cardiac events-occurred[heartrate:66?59,73?vs 70?64,77?;LVEF:29?22,34?vs 35?29,38?;-PER:1.03±0.25 vs 1.34±0.23;PFR:1.01±0.24 vs 1.31±0.24]?P<0.05?.3.Optimal cutoffs for predicting cardiac events of-PER and PFR were 1.13 EDV/s and 1.12 EDV/s.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients with-PER?1.13 EDV/s than patients with-PER>1.13 EDV/s?20.5%vs 72.4%,?²=82.3,P<0.001?,in patients with PFR?1.12EDV/s than patients with PFR>1.12 EDV/s?22.1%vs 73.3%,?²=76.21,P<0.001?.Multivariate analysis showed that PER?HR=0.31,95%CI:0.14⁰.71?and PFR?HR=0.39,95%CI:0.17⁰.89?were independent predictors for cardiac events.Conclusion:1.There was a great correlation between PER and PFR in patients with LVSD after AMI with revascularization.There were better correlation between PER,PFR and the parameters of LVEF,EDV,ESV evaluating ventricular function than between PER,PFR and the parameters SRS,TPD evaluating myocardial perfusion.2.Heartrate,LVEF,EDV,ESV,PER and PFR were predictors for cardiac events in patients with LVSD after AMI with revascularization,but PER and PFR were independent predictors for cardiac events.