[Prognostic value of SPECT myocardial perfusion imaging parameters in patients with ischemic heart disease of different sexes].

Objective: To investigate the prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging parameters in patients with ischemic heart disease of different sexes. Methods: This retrospective cohort study consecutively enrolled patients diagnosed with ischemic heart disease who underwent rest gated SPECT myocardial perfusion imaging at the First Hospital of Shanxi Medical University between 2016 and 2021. Patients were followed up and categorized into good and poor prognosis groups within each sex based on the occurrence of major adverse cardiovascular events. Propensity score matching was used to balance clinical covariates between prognostic groups within each sex, and differences in SPECT myocardial perfusion imaging parameters were compared between groups. Multivariate Cox regression analysis was performed to identify prognostic factors for patients of different sexes. Results: A total of 1 475 patients completed follow-up (follow-up time: 3.05 (1.71,4.97) years), with an age of (60.5±12.7) years, including 1 058 males (71.7%). After propensity score matching, 866 males (433 in the good prognosis group and 433 in the poor prognosis group) and 302 females (151 in the good prognosis group and 151 in the poor prognosis group) were included. No statistically significant differences were observed in baseline clinical characteristics between prognostic groups within each sex (all P>0.05). Among male patients, the poor prognosis group exhibited higher total perfusion deficit, lower eccentricity index, left ventricular ejection fraction, and peak filling rate compared to the good prognosis group. Among female patients, the poor prognosis group demonstrated a lower peak filling rate than the good prognosis group (all P<0.05). Multivariate Cox regression analysis revealed that increased total perfusion deficit (HR=1.01, 95%CI: 1.00-1.02) and decreased eccentricity index (HR=0.14, 95%CI: 0.02-0.93) were independent risk factors in male patients, whereas decreased peak filling rate (HR=0.67, 95%CI: 0.50-0.91) was an independent risk factor in female patients (all P<0.05). Conclusions: Sex-specific differences exist in the prognostic value of SPECT myocardial perfusion imaging parameters for ischemic heart disease. Increased total perfusion deficit and decreased eccentricity index are independent risk factors in male patients, while decreased peak filling rate is an independent risk factor in female patients.