Prognostic Impact of Body Mass Index on Coronary Artery Disease Using Gated Myocardial Perfusion Imaging-Single Photon Computed Tomography

Asad Jalil; Sajid  Sattar; Imtiaz Ul Haque  Khurshaidi; Aitadal  Rameez

doi:10.36283/PJMD13-3/017

Authors

Asad Jalil Ziauddin University
Sajid Sattar Ziauddin University
Imtiaz Ul Haque Khurshaidi Ziauddin University
Aitadal Rameez Ziauddin University

DOI:

https://doi.org/10.36283/PJMD13-3/017

Abstract

Background: Gated Myocardial Perfusion Imaging Single-Photon Emission Computed Tomography (GMPI-SPECT) is a nuclear stress test; performed to observe perfusion of cardiac tissue and its related defects; to diagnose / stratifying risk in individuals either suspected or known cases of coronary artery disease (CAD) whereas body mass index (BMI) is used for screening of obesity. The objective of this study was to investigate the impact of BMI on the prognosis of intermediate-risk CAD patients, stratified by GMPI-SPECT results in both genders.

Methods: Ziauddin University Hospital was the setting of this prospective cross-sectional descriptive study, from March 2017 to December 2019 using non-probability purposive sampling. Non-obese and obese GMPI-SPECT patients (n=115) were divided into two major groups (male and female). Patients were interviewed after 18 months regarding cardiac events with/without interventional procedures. SPSS v.23 was used with p<0.05 considered significant.

Results: In the study, 56.5% were male, 57.4% were obese, and higher BMI males with an intermediate risk prognosis on GMPI-SPECT have a 7.5% risk of minor cardiac events. In post hoc analysis it was observed that samples with intermediate risk have significantly higher BMI as compared to high-risk samples p=0.028). Pearson Chi-Square test gives a significant association between GMPI-SPECT outcomes and 18-month intervals with a p<0.01. One-way ANOVA gives a significant mean difference in BMI concerning GMPI-SPECT outcomes (p<0.05).

Conclusion: The study findings suggest that men with higher BMI, multiple risk factors, and intermediate risk prognosis on GMPI-SPECT do have a risk of experiencing a minor cardiac incident within 18 months.

Keywords: Gated-Myocardial Perfusion Imaging-SPECT, Body Mass Index, Coronary Artery Disease.

Author Biographies

Asad Jalil, Ziauddin University

Ziauddin University
Sajid Sattar, Ziauddin University

MEDICAL TECHNOLOGY
Imtiaz Ul Haque Khurshaidi, Ziauddin University

Ziauddin University
Aitadal Rameez, Ziauddin University

Sr. NMTechnologiest Nuclear medicine

References

Gui J, Li Y, Liu H, Guo LL, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C. Obesity-and lipid-related indices as a predictor of obesity metabolic syndrome in a national cohort study. Frontiers in public health. 2023; 11:1073824. https://doi.org/10.3389/fpubh.2023.1073824.

Fatima N, uz Zaman M, Ishaq M, Rasheed SZ, Baloch DJ, Wali A, Bano J, Rehman K. Higher events rate in patients with a normal gated myocardial perfusion imaging with dipyridamole than exercise:“Run for reliability”. Indian Journal of Nuclear Medicine. 2012 Jul 1;27(3):172-5. doi: 10.4103/0972-3919.112722.

Ather S, Iqbal F, Gulotta J, Aljaroudi W, Heo J, Iskandrain AE, et al. Comparison of three commercially available software for measuring left ventricular perfusion and function by gated SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 2014; 21,673–681. doi: 10.1007/s12350-014-9885-5

Hamirani YS, Kramer CM. Cardiac MRI assessment of myocardial perfusion. Future Cardiol. 2014; 10(3):349-358. doi: 10.2217/fca.14.18

Kang X, Shaw LJ, Hayes SW, Hachamovitch R, Abidov A, Cohen I. Impact of Body Mass Index on Cardiac Mortality in Patients with Known or Suspected Coronary Artery Disease Undergoing Myocardial Perfusion Single-Photon Emission Computed Tomography. J Am Coll Cardiol 2006; 47:1418-1426 doi: 10.1016/j.jacc.2005.11.062

Weir CB, Jan A. BMI classification percentile and cut off points. 2023.

Fatima SS, Rehman R, Chaudhry B. Body mass index or body fat! which is a better obesity scale for Pakistani population? JPMA: Journal of the Pakistan Medical Association. 2014;64(11):1225.

Roberto CA, Swinburn B, Hawkes C, Huang TT, Costa SA, Ashe M, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385(9985):2400-2409. doi: 10.1016/S0140-6736(14)61744-X

Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, Kannel WB, Vasan RS. Obesity and the risk of heart failure. N Engl J Med. 2002;347(5):305-313. doi: 10.1056/NEJMoa020245

Danad I, Uusitalo V, Kero T, Saraste A, Raijmakers PG, Lammertsma AA, Heymans MW, Kajander SA, Pietilä M, James S, Sörensen J. Quantitative assessment of myocardial perfusion in the detection of significant coronary artery disease: cutoff values and diagnostic accuracy of quantitative [15O] H2O PET imaging. Journal of the American College of Cardiology. 2014;64(14):1464-1475. https://doi.org/10.1016/j.jacc.2014.05.069

Zaman MU, Fatima N, Samad A, Ishaq M, Rasheed Z, Baloch DJ, et al. Overall and gender based negative predictive value of a normal gated myocardial perfusion SPECT study: A single center experience. Ann Nucl Med. 2011; 25:207–211. doi: 10.1007/s12149-010-0446-y

Labounty TM, Gomez MJ, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, et al. Body mass index and the prevalence, severity, and risk of coronary artery disease: an international multicentre study of 13,874 patients. Eur Heart J Cardiovasc Imaging. 2013;14(5):456-463. doi: 10.1093/ehjci/jes179

DePuey EG. Myocardial Perfusion SPECT. 2012.

Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular Risk and Events in 17 Low-, Middle-, and High Income Countries. N Engl J Med. 2014; 371:818-827. doi: 10.1056/NEJMoa1311890

Barolia R, Sayani AH. Risk factors of cardiovascular disease and its recommendations in Pakistani context. J Pak Med Assoc. 2017;67(11):1723-1729.

Turin TC, Shahana N, Wangchuk LZ, Specogna AV, Al Mamun M, Khan MA, et al. Burden of Cardio- and Cerebro-vascular Diseases and the Conventional Risk Factors in South Asian Population. Glob Heart. 2013;8(2):121-130. doi: 10.1016/j.gheart.2012.01.001

Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. doi: 10.1093/eurheartj/eht296.

Kostkiewicz M. Myocardial perfusion imaging in coronary artery disease. Cor Vasa. 2015;57(6):e 446-452. https://doi.org/10.1016/j.crvasa.2015.09.010

Chantadisai M, Sirisalipoch S, Vachatimanont S. Utility of gated SPECT parameters in detection of coronary artery disease in patients with normal perfusion images. Egyptian Journal of Radiology and Nuclear Medicine. 2022;53(1):257. https://doi.org/10.1186/s43055-022-00944-4

Elhendy A, Schinkel AF, van Domburg RT, Bax JJ, Valkema R, Biagini E, et al. Prognostic stratification of obese patients by stress 99mTc-tetrofosmin myocardial perfusion imaging. J Nucl Med. 2006;47(8):1302-1306.

Duvall WL, Croft LB, Corriel JS, Einstein AJ, Fisher JE, Haynes PS, et al. SPECT myocardial perfusion imaging in morbidly obese patients: image quality, hemodynamic response to pharmacologic stress, and diagnostic and prognostic value. J Nucl Cardiol. 2006;13(2):202-209. doi: 10.1007/BF02971244

Canoy D, Cairns BJ, Balkwill A, Wright FL, Green J, Reeves G, et al. Million Women Study Collaborators. Body mass index and incident coronary heart disease in women: a population-based prospective study. BMC Med. 2013;11:87. doi: 10.1186/1741-7015-11-87

Simati S, Kokkinos A, Dalamaga M, Argyrakopoulou G. Obesity Paradox: Fact or Fiction? Current Obesity Reports. 2023 Jun;12(2):75-85. DOI: 10.1007/s13679-023-00497-1.