Cardiovascular outcomes are predicted by exercise-stress myocardial perfusion imaging: Impact on death, myocardial infarction, and coronary revascularization procedures

Lee, Douglas S.; Verocai, Flavia; Husain, Mansoor; Khdair, Darar Al; Wang, Xuesong; Freeman, Michael R.; Iwanochko, Robert M.

doi:10.1016/j.ahj.2011.01.019

Cited by 21 publications

(8 citation statements)

References 23 publications

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“…This study was followed by a subsequent study detailing the prognosis of 509 patients who achieved ≥10 METs and were found to have very low rates of cardiac mortality, non-fatal myocardial infarction (MI), and late revascularization irrespective of heart rate achieved [2]. This work was validated by a study in the Canadian healthcare system in which 4,215 patients attained ≥10 METs without ST changes who had a low frequency of stress perfusion defects, significant left ventricular ischemia, and a composite of death, MI, or late revascularization [21]. In a study of 7,236 patients undergoing treadmill exercise echocardiography who achieved ≥10 METs of exertion during testing, work from the Mayo Clinic found that these patients infrequently (4 %) had extensive ischemia and overall had an excellent prognosis [4].…”

Section: Discussionmentioning

confidence: 96%

Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing

Duvall

Savino

Levine

et al. 2014

Eur J Nucl Med Mol Imaging

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Section: Discussionmentioning

confidence: 96%

Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing

Duvall

Savino

Levine

et al. 2014

Eur J Nucl Med Mol Imaging

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“…(19) The favorable diagnostic and prognostic impact of achieving a high exercise workload has been confirmed in multiple subsequent studies, including a Canadian cohort of 9,605 patients, and an analysis using patients who underwent exercise echocardiography. (20,21) In the Canadian population, there was a 1% risk of ≥10% LV ischemia and a death or MI rate <2% even in those with ≥5% LV ischemia. Some studies have shown exercise echocardiography and MPI to retain prognostic significance after accounting for workload.…”

Section: Additional Tools To Increase Diagnostic and Prognostic Utilitymentioning

confidence: 99%

Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies

Bourque

Beller

2015

JACC: Cardiovascular Imaging

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Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms able to exercise. Although, stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables, or without concurrent imaging. In addition to exercise-induced ischemic ST depression, such markers as ST segment elevation in lead AVR, abnormal heart rate recovery post-exercise, failure to achieve target heart rate, and poor exercise capacity improve risk stratification of ExECG. For example, patients achieving ≥10 METS on ExECG have a very low prevalence of inducible ischemia and an excellent prognosis. In contrast, cardiac imaging techniques add diagnostic and prognostic value in higher risk populations (e.g. poor functional capacity, diabetes, chronic kidney disease). Optimal test selection for symptomatic patients with suspected coronary artery disease requires a patient-centered approach factoring in the risk/benefit ratio and cost-effectiveness.

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“…Cardiac screening tests, such as a stress echocardiogram or electrocardiogram, which are considered the gold standard for cost-eff ective screening (20), are recommended only in certain circumstances. If a person is going to be in a medium or heavier physical activity, it is advisable to screen that person for cardiac risk factors with objective tests before he or she is exposed to the stress of a hot environment, in order to mitigate the risk for adverse cardiac events.…”

Section: Cardiac Functionmentioning

confidence: 99%

Screening for Heat Stress in Workers and Athletes

Ramphal-Naley

2012

Baylor University Medical Center Proceedings

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eat-related illnesses lead to almost 6000 hospital visits per year, or two emergency department visits per 100,000 visits. Heat-related illnesses are most high among men (72%) aged 15 to 19 years and are most often associated with athletic activities (1). Global climate change will continue to have an impact on heat stress in people, on animal survival, and on food availability. Th e World Health Organization has estimated that over the past 30 years, 150,000 lives have been lost annually due to global heat waves and climate change (2). Weather changes have a great impact on athletes and workers by slowing effi ciency and decreasing productivity (3, 4). When heat waves occur, overall mortality is also aff ected among the old and the young, due to their increased risk of dying from cardiovascular, respiratory, cerebrovascular, and some cardiovascular diseases, such as ischemic heart disease, heart failure, and myocardial infarction (3). Despite increasing temperatures and environmental levels of carbon dioxide, one third of metropolitan areas do not have heat stress response plans (5). Cases of heat stress are handled on a case-by-case basis rather than by being addressed collectively as a public health concern. Th e National Institute for Occupational Safety and Health initiated heat stress criteria in 1986 and amended them in 2008 regarding worker heat stress safety (6). Few people are aware of these criteria, of the risk factors associated with a predisposition to heat stress, or of the signs or symptoms to look for that represent risk factors for heat stress. Th e rules and standards proposed by the Occupational Safety and Health Administration for workplace heat stress are recommendations and still not enforceable (7). Screening for heat stress susceptibility in workers and athletes is an issue in need of public health criteria with enforceable rules based on evidence-based research. Screening for heat stress risk factors should consider physical demand level; cardiovascular, pulmonary, and endocrine status; previous history of heat stress; age; diseases; and medications including illegal drug use. Such screening should be part of the recruitment of any person expected to work or play in extremely hot environmental conditions. Older people are at increased risk for cardiovascular and thermoregulatory instability. Th e aging American workforce, undiagnosed disease, poor hydration while working or playing, and global warming are all factors that contribute to the need to screen workers and athletes for the risk of heat stress (8).

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Cardiovascular outcomes are predicted by exercise-stress myocardial perfusion imaging: Impact on death, myocardial infarction, and coronary revascularization procedures

Cited by 21 publications

References 23 publications

Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing

Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing

Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies

Screening for Heat Stress in Workers and Athletes

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