Higher event rate in patients with high-risk Duke Treadmill Score despite normal exercise-gated myocardial perfusion imaging

Abstract

This prospective study was carried out to find the negative predictive value of various Duke Treadmill Scores (DTSs) in patients with normal myocardial perfusion imaging (MPI). This study was conducted from August 2012 to July 2015, and 603 patients having normal exercise MPIs were included. Patients were followed for 2 years for fatal myocardial infarction (FMI) and nonfatal myocardial infarction (NFMI). Follow-up was not available in 23 patients, leaving a cohort of 583 participants. DTS was low risk (≥5) in 286, intermediate risk (between 4 and − 10) in 211, and high risk (≤−11) in 86 patients. Patients with high- and intermediate-risk DTS were significantly elder than low-risk DTS cohort. Patients with high-risk DTS had significantly higher body mass index with male preponderance compared to other groups. No significant difference was found among three groups regarding modifiable or nonmodifiable risk factors and left ventricular ejection fraction. On follow-up, single FMI was observed in high-risk DTS group (log-rank test value = 5.779, P = 0.056). Five NFMI events were observed in high-risk DTS (94.2% survival; log-rank test value = 19.398, P = 0.0001; significant) as compared to two events each in low- and intermediate-risk DTS (nonsignificant). We conclude that patients with normal exercise MPI and low-to-intermediate risk DTS have significantly low NFMI. High-risk DTS despite normal exercise MPI had high NFMI. Further, validation studies to find the predictive value of symptomatic and asymptomatic ST deviation resulting in high-risk DTS in patients with normal exercise MPI are warranted.

Correlation of Duke Treadmill Score with Coronary angiographic Findings in Patients with Stable Ischemic Heart Disease

“…7 Duke Treadmill score is an important predictor of CAD 8,9 as well as the prognosis 10 . Zaman M et al 11 This finding reinforces the regional as well as ethnic differences in the trends of CAD and its risk factors. Another important inference from our results was that there was a significantly different prevalence of obstructive CAD in the patients who had typical symptoms of angina pectoris as compared to the ones who presented with atypical symptoms.…”

Ability of the prognostic model of J-ACCESS study to predict cardiac events in a clinical setting: The APPROACH study

“…We found high cardiac risk even with low SSS. Previous studies have shown that patients even with normal MPI occasionally had some cardiac risk [8,9]. One reason might be the fact that MPI cannot detect perfusion abnormality when it is distributed equally as seen in balanced ischemia.…”

Can high-sensitive troponin levels within the normal range predict positivity in treadmill test?

“…After the test, the Duke treadmill score (DTS) was calculated using the exercise time, ST deviation, and angina class [17]. The DTS was grouped into low-risk (with a score of ≥+5), moderate-risk (with scores ranging from −10 to +4), and high-risk (with a score of ≤−11) categories.…”