lthough B-type natriuretic peptide (BNP) has emerged as an important predictor not only for heart failure but also for myocardial ischemic events, 1-4 its effect on scintigraphic parameters derived from single-photon emission computed tomography (SPECT) is unknown. We previously reported in the Quantitative gated SPECT Prognostic Value in the Elderly (Q-PROVE) study that stress myocardial SPECT successfully stratified the risk for subsequent cardiac events in 175 elderly patients with a mean age of 79 years. 5 In addition to the prognostic value of myocardial SPECT, therefore, we performed a post-hoc analysis of the Q-PROVE study to elucidate the prognostic value of BNP in elderly patients with known or suspected coronary artery disease (CAD).
Methods
SubjectsThe Q-PROVE study initially enrolled 182 elderly patients aged 75-85 years from 11 institutions. 5 Consecutive elderly patients who underwent gated SPECT in each institution for the evaluation of known or suspected CAD because of clinical symptoms, multiple coronary risk factors or abnormal ECG were eligible for enrollment. The following were the exclusion criteria: (1) age <75 years or >85 years, (2) acute heart failure, (3) atrial fibrillation, (4) acute myocardial infarction within 3 months before the SPECT study, (5) coronary revascularization within 3 months after the SPECT study, (6) serious concomitant hepatic or renal disease, (7) malignancy or any other illness with a poor prognosis. Of the 182 patients who participated in this study, 3 patients underwent coronary revascularization within 3 months after the SPECT study, and 4 patients were lost to follow-up. In addition, BNP was not measured within 3 months of the study in 73 patients, which left 102 patients for this post-hoc analysis.
Study ProtocolApplying the inclusion and exclusion criteria for the Q-PROVE study, patients were prospectively evaluated by primary physicians, cardiologists or both who were responsible for the SPECT study, and who assessed the past medical history including classical coronary risk factors. The patients underwent stress/rest myocardial perfusion
Comparative Impact of Scintigraphic Parameters and B-Type Natriuretic Peptide for the Prediction of Major Cardiac Events in the QGS-Prognostic Value in the Elderly (Q-PROVE) StudyYuko Igarashi, MD; Taishiro Chikamori, MD; Satoshi Hida, MD; Tadashi Nagao, MD; Hirokazu Tanaka, MD; Yasuhiro Usui, MD; Tsuguhisa Hatano, MD; Takayuki Morishima, MD; Hidefumi Yanagisawa, MD; Akira Yamashina, MD Background: Although B-type natriuretic peptide (BNP) has emerged as an important predictor for cardiac events, its effect on scintigraphic parameters is unknown.
Methods and Results:The Q-PROVE study is a multicenter study to evaluate the prognostic value of ECG-gated SPECT in 175 Japanese elderly patients. In addition, BNP was assessed in 102 patients. Outcome assessment included cardiac events and noncardiac deaths. Twelve elderly patients (12%) had increased BNP >130 pg/ml. The summed stress score (SSS) was greater in patients with incr...