Abstract
The prognostic power of myocardial perfusion imaging in patients with ischemic heart disease (IHD) has been demonstrated since planar imaging. We aimed to investigate whether gated SPECT retains this value in current cardiology if compared with a complete diagnostic work-up and with more recent prognostic indicators. Methods: We selected from our database a cohort of 676 consecutive inpatients who underwent a complete diagnostic work-up that included gated SPECT and coronary arteriogra-phy for known or suspected IHD. Patients with acute myocardialinfarction (MI), previous coronary artery bypass surgery, or overt hyperthyroidism and patients who were undergoing dialysis treatment were excluded. During follow-up (median, 37 mo), 24 patients died from cardiac causes and 19 experienced a nonfatal MI. Results: The following were determined to be independent predictors of event-free survival (cardiac death and nonfatal MI) in the different phases of diagnostic work-up using Cox proportional hazards regression analysis: among clinical variables, a previous MI; among laboratory examinations, serum creatinine and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels; among electrocardiographic and echocardiography variables, left ventricular ejection fraction; and among SPECT variables, summed rest score (SRS) and summed difference score (SDS). In addition, a score of coronary stenoses at angiography was an independent predictor. When the above predictors were tested together, SRS (P <0.0001), SDS (P=0.0108), and serum creatinine (P=0.0186) and LDL and HDL cholesterol levels (P=0.0222) were the final independent predictors of event-free survival. When gated SPECT was added to the clinical, laboratory, electrocardiographic, and echocardiography variables, the prognostic stratification significantly improved (P <0.05); when coronary arteriography was added to gated SPECT, prognostic stratification did not further improve (P > 0.25). If the information provided by gated SPECT was made available after clinical, laboratory, electrocardiographic, echocardiographic, and angiographic variables, the prognostic stratification still improved significantly (P <0.05). In 492 of these patients with ascertained IHD, SRS and SDS were the final independent predictors of survival. Medical treatment and coronary revascularization did not affect the prognostic information of gated SPECT. Conclusion: Myocardial perfusion abnormalities at rest and after stress are still the best predictors of cardiac eventfree survival in patients with known or suspected IHD, even when compared with an extensive diagnostic work-up. COPYRIGHT
| Original language | English |
|---|---|
| Pages (from-to) | 546-553 |
| Number of pages | 8 |
| Journal | Journal of Nuclear Medicine |
| Volume | 50 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 1 2009 |
Fingerprint
Keywords
- Gated spect
- Ischemic heart disease
- Laboratory tests
- Myocardial perfusion imaging
- Prognosis
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
Stress/Rest myocardial perfusion abnormalities by gated SPECT : Still the best predictor of cardiac events in stable ischemic heart disease. / Gimelli, Alessia; Rossi, Giuseppe; Landi, Patrizia; Marzullo, Paolo; Iervasi, Giorgio; L'Abbate, Antonio; Rovai, Daniele.
In: Journal of Nuclear Medicine, Vol. 50, No. 4, 01.04.2009, p. 546-553.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Stress/Rest myocardial perfusion abnormalities by gated SPECT
T2 - Still the best predictor of cardiac events in stable ischemic heart disease
AU - Gimelli, Alessia
AU - Rossi, Giuseppe
AU - Landi, Patrizia
AU - Marzullo, Paolo
AU - Iervasi, Giorgio
AU - L'Abbate, Antonio
AU - Rovai, Daniele
PY - 2009/4/1
Y1 - 2009/4/1
N2 - The prognostic power of myocardial perfusion imaging in patients with ischemic heart disease (IHD) has been demonstrated since planar imaging. We aimed to investigate whether gated SPECT retains this value in current cardiology if compared with a complete diagnostic work-up and with more recent prognostic indicators. Methods: We selected from our database a cohort of 676 consecutive inpatients who underwent a complete diagnostic work-up that included gated SPECT and coronary arteriogra-phy for known or suspected IHD. Patients with acute myocardialinfarction (MI), previous coronary artery bypass surgery, or overt hyperthyroidism and patients who were undergoing dialysis treatment were excluded. During follow-up (median, 37 mo), 24 patients died from cardiac causes and 19 experienced a nonfatal MI. Results: The following were determined to be independent predictors of event-free survival (cardiac death and nonfatal MI) in the different phases of diagnostic work-up using Cox proportional hazards regression analysis: among clinical variables, a previous MI; among laboratory examinations, serum creatinine and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels; among electrocardiographic and echocardiography variables, left ventricular ejection fraction; and among SPECT variables, summed rest score (SRS) and summed difference score (SDS). In addition, a score of coronary stenoses at angiography was an independent predictor. When the above predictors were tested together, SRS (P <0.0001), SDS (P=0.0108), and serum creatinine (P=0.0186) and LDL and HDL cholesterol levels (P=0.0222) were the final independent predictors of event-free survival. When gated SPECT was added to the clinical, laboratory, electrocardiographic, and echocardiography variables, the prognostic stratification significantly improved (P <0.05); when coronary arteriography was added to gated SPECT, prognostic stratification did not further improve (P > 0.25). If the information provided by gated SPECT was made available after clinical, laboratory, electrocardiographic, echocardiographic, and angiographic variables, the prognostic stratification still improved significantly (P <0.05). In 492 of these patients with ascertained IHD, SRS and SDS were the final independent predictors of survival. Medical treatment and coronary revascularization did not affect the prognostic information of gated SPECT. Conclusion: Myocardial perfusion abnormalities at rest and after stress are still the best predictors of cardiac eventfree survival in patients with known or suspected IHD, even when compared with an extensive diagnostic work-up. COPYRIGHT
AB - The prognostic power of myocardial perfusion imaging in patients with ischemic heart disease (IHD) has been demonstrated since planar imaging. We aimed to investigate whether gated SPECT retains this value in current cardiology if compared with a complete diagnostic work-up and with more recent prognostic indicators. Methods: We selected from our database a cohort of 676 consecutive inpatients who underwent a complete diagnostic work-up that included gated SPECT and coronary arteriogra-phy for known or suspected IHD. Patients with acute myocardialinfarction (MI), previous coronary artery bypass surgery, or overt hyperthyroidism and patients who were undergoing dialysis treatment were excluded. During follow-up (median, 37 mo), 24 patients died from cardiac causes and 19 experienced a nonfatal MI. Results: The following were determined to be independent predictors of event-free survival (cardiac death and nonfatal MI) in the different phases of diagnostic work-up using Cox proportional hazards regression analysis: among clinical variables, a previous MI; among laboratory examinations, serum creatinine and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels; among electrocardiographic and echocardiography variables, left ventricular ejection fraction; and among SPECT variables, summed rest score (SRS) and summed difference score (SDS). In addition, a score of coronary stenoses at angiography was an independent predictor. When the above predictors were tested together, SRS (P <0.0001), SDS (P=0.0108), and serum creatinine (P=0.0186) and LDL and HDL cholesterol levels (P=0.0222) were the final independent predictors of event-free survival. When gated SPECT was added to the clinical, laboratory, electrocardiographic, and echocardiography variables, the prognostic stratification significantly improved (P <0.05); when coronary arteriography was added to gated SPECT, prognostic stratification did not further improve (P > 0.25). If the information provided by gated SPECT was made available after clinical, laboratory, electrocardiographic, echocardiographic, and angiographic variables, the prognostic stratification still improved significantly (P <0.05). In 492 of these patients with ascertained IHD, SRS and SDS were the final independent predictors of survival. Medical treatment and coronary revascularization did not affect the prognostic information of gated SPECT. Conclusion: Myocardial perfusion abnormalities at rest and after stress are still the best predictors of cardiac eventfree survival in patients with known or suspected IHD, even when compared with an extensive diagnostic work-up. COPYRIGHT
KW - Gated spect
KW - Ischemic heart disease
KW - Laboratory tests
KW - Myocardial perfusion imaging
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=63849120042&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=63849120042&partnerID=8YFLogxK
U2 - 10.2967/jnumed.108.055954
DO - 10.2967/jnumed.108.055954
M3 - Article
C2 - 19289433
AN - SCOPUS:63849120042
VL - 50
SP - 546
EP - 553
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
SN - 0161-5505
IS - 4
ER -