Lin, Chih-YiChih-YiLinTang, Li-HuaLi-HuaTangChou, Yi-HsienYi-HsienChouCHI-LUN KOMEI-FANG CHENGChen, Chien-JungChien-JungChenKUAN-YIN KOCHIA-JU LIU2025-08-292025-08-292025-06-2709147187https://scholars.lib.ntu.edu.tw/handle/123456789/731730Purpose: The study aimed to assess the prognostic value of non-perfusion parameters for gated myocardial perfusion imaging (MPI) performed using Cadmium-Zinc-Telluride (CZT) single-photon emission computed tomography (SPECT) for individuals with normal myocardial perfusion. Methods: We analyzed data from consecutive patients who underwent thallium-201 MPI SPECT with normal perfusion. Major adverse cardiovascular events (MACEs) were recorded during a 2-year follow-up. Non-perfusion parameters were evaluated as predictors of MACEs. Results: Among 1570 patients with normal SPECT perfusion, 80 (5.1%) experienced MACEs over a mean follow-up of 22.5 ± 10.8 months: 12 (0.8%) had cardiac death, and 68 (4.3%) underwent coronary revascularization due to significant coronary artery disease. Independent predictors of MACEs included worsening post-stress ejection fraction (HR: 1.971; p = 0.008), and increased lung-to-heart ratio (HR: 2.207; p = 0.001). Kaplan–Meier analysis showed the highest MACEs’ incidence in patients with two of these factors (p < 0.001). Among patients with normal resting ejection fraction, EF worsening (OR: 2.16; p = 0.004) and increased lung-to-heart ratio (OR: 1.91; p = 0.0013) both remained strong predictors. Conclusions: Although normal myocardial perfusion typically indicates low risk for obstructive coronary artery disease, worsening post-stress ejection fraction and increased lung-to-heart ratio are crucial prognostic indicators. Importantly, these non-perfusion parameters retain their prognostic value even in patients without clinical heart failure, highlighting their relevance in comprehensive risk stratification beyond perfusion assessment alone.enfalseCadmium Zinc Telluride (CZT)Major adverse cardiovascular events (MACEs)Non-perfusion parametersPost-stress ejection fractionSingle photon emission computed tomography (SPECT)[SDGs]SDG3journal article10.1007/s12149-025-02077-w405767352-s2.0-105009237830