ArticleEuropean journal of nuclear medicine and molecular imaging2025
Myocardial flow reserve derived from D-SPECT for evaluating non-culprit ischemic lesions in STEMI patients: comparison with quantitative flow ratio.
Article in European journal of nuclear medicine and molecular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Intracoronary nicorandil improves coronary microcirculatory function after primary PCI in first-episode STEMI: an angiography-derived evaluation using AMR and QFR.Frontiers in cardiovascular medicine · 2026Article
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14 authors.
Funding
Abstract
objectivesThis study sought to elucidate the diagnostic performance and concordance between myocardial flow reserve (MFR) derived from dynamic single-photon emission computed tomography (D-SPECT) and quantitative flow ratio (QFR) in evaluating non-culprit ischemic lesions following ST-elevation myocardial infarction (STEMI). Additionally, the study investigated the integration of MFR with angiographic microvascular resistance (AMR) derived from coronary angiography to determine its utility in screening and stratifying non-culprit ischemic lesions.
backgroundThe diagnostic performance and agreement between MFR and QFR in evaluating non-culprit ischemic lesions in STEMI patients with multivessel disease are unknown.
methodsThis research encompassed a cohort of 106 STEMI patients with at least 1 intermediate non-culprit ischemic lesion, characterized by 40-80% diameter stenosis. After undergoing percutaneous coronary intervention, patients were evaluated using QFR and, approximately five days later, underwent D-SPECT to assess myocardial blood flow (MBF) and MFR. MFR was evaluated against QFR as a reference for diagnostic performance and agreement, including sensitivity analysis in vessels with normal microvascular function. Furthermore, MFR, combined with AMR, effectively screened and stratified non-culprit ischemic lesions. Non-culprit ischemic lesions were defined by QFR ≤ 0.80 and normal microvascular function by AMR < 255 mmHg*s/m.
resultsAmong non-culprit lesions, MFR predicted a QFR ≤ 0.80 with a sensitivity of 85%, specificity of 86%, and accuracy of 86%. The positive predictive value was 56%, and the negative predictive value was 96%. The MFR cut-off was 1.93, with an area under the receiver operating characteristic curve of 0.90 (95% CI: 0.84 to 0.94). MFR showed similar diagnostic performance in patients with normal microcirculation. Moreover, low MFR with normal AMR indicated non-culprit ischemic lesions caused solely by epicardial narrowing, while low MFR with abnormal AMR indicated ischemic lesions complicated by microvascular dysfunction.
conclusionMFR derived from D-SPECT exhibits good diagnostic performance and moderate agreement in identifying non-culprit ischemic lesions in patients with STEMI. Combining AMR with MFR effectively screens and stratifies non-culprit ischemic lesions.
trial registrationChiCTR.org.cn. ChiCTR2200059934. Registered 13 May 2022.
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