Abstract
<title>Abstract</title> <p>Background Myocardial perfusion imaging (MPI) represents an important modality for the evaluation, risk stratification, and management of ischemic heart disease (IHD). It provides functional information regarding myocardial blood flow under resting and stress conditions. Aim estimation of myocardial salvage (MS) using early gated single-photon emission computed tomography (SPECT), and evaluation of its predictive role for left ventricular ejection fraction (LVEF) recovery and ventricular remodeling following primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods This prospective cohort study enrolled 60 adult patients diagnosed with STEMI and managed by primary PCI at Kasr Al-Aini Hospitals, Cairo University, between November 2022 and June 2024. Gated SPECT imaging was performed early after primary PCI and repeated at follow-up for assessment of infarct size, perfusion abnormalities, and ventricular performance. Results Myocardial salvage demonstrated a strong positive correlation in both early and follow-up LVEF with (r = 0.744, p < 0.001), (r = 0,879, p < 0.001), respectively. LVEF recovery was more frequent among patients with anterior infarction than inferior infarction (72.2% vs. 25%, p = 0.011). Receiver operating characteristic analysis revealed superior predictive performance of MS for LVEF recovery compared with infarct size (AUC = 0.88 vs. 0.63), with an optimal cutoff value > 27%, sensitivity of 72%, and specificity of 70%. Conclusions Early gated SPECT assessment of myocardial salvage and infarct size may provide clinically valuable prognostic information regarding ventricular functional recovery after primary PCI in acute myocardial infarction.</p>