Incremental prognostic value of myocardial SPET with dual-isotope rest 201Tl/stress 99mTc-tetrofosmin

Abstract

The incremental prognostic value of dual-isotope myocardial perfusion scintigraphy using technetium-99m tetrofosmin for the stress images was evaluated in 597 consecutive patients with known or suspected coronary artery disease. We used semi-quantitative visual analysis with a five-point scoring system and calculated the summed stress score, the summed rest score and the summed difference score. During the 2-year follow-up period, 46 "hard" cardiac events occurred: 16 cardiac deaths and 30 non-fatal myocardial infarctions. Kaplan-Meier analysis demonstrated a favourable prognosis for patients with normal scans as compared with patients with mildly to moderately or severely abnormal scans ( P<0.001). Multivariate analysis demonstrated incremental prognostic information for nuclear variables. A very low rate of hard cardiac events was observed in patients with a low summed stress score. Thus, nuclear variables provide incremental prognostic information and could be used to guide the management process with respect to whether or not to proceed with further invasive procedures.

The additive prognostic value of perfusion and functional data assessed by quantitative gated SPECT in women

“…This may be explained by the fact that our population was 10 years younger. In a matched aged group, Groutars et al 24 found similar event rates compared to our study (0.4% vs 0.7% annual CD rate for normal perfusion, 2.1% vs 2.4% annual CD for moderate to severely abnormal images). Similar results were found for hard cardiac events.…”

“…In particular the SSS has been shown to be a powerful independent predictor of cardiac events. 10,[22][23][24] However, most of the observations have been made in a mixed gender population. 10,22-24 Sharir et al 11 showed that for CD and MI, perfusion data provided a larger proportion of the prognostic information for women than they did for men.…”

Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events

“…[16][17][18][19] Previous reports demonstrated that an abnormal MPS is associated with an increased event rate depending on baseline characteristics. [18][19][20][21] The presence of LBBB and LBBB-pattern related to RVA pacing, hampers non-invasive analysis and risk stratification of patients with chest pain. 13 The surface ECG is abnormal and ischemic changes during exercise are difficult to detect or interpret.…”

“…Studies that evaluated the value of MPS in patients with normal left ventricular activation were carried out in younger patient population with a relatively low pre-test probability compared to the studies performed in patients with an abnormal left ventricular activation pattern. 17,[19][20][21][23][24][25][26][27][28] In view of the aforementioned considerations, a higher event rate for patients with LBBB or RVA pacing could be expected a priori compared with the known results of low-risk MPS when normal left ventricular conduction is present. Also, the relatively high cardiac event rates in patients with low-risk MPS but abnormal left ventricular activation patterns may be explained by the higher mean age and the pre-test cardiac risk in the studies that assessed patients with LBBB or RVA pacing.…”

Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

“…The diagnostic and prognostic values of stress myocardial perfusion imaging (MPI) is well established with SPECT [1][2][3][4][5][6][7][8][9][10][11][12] and more recently with PET or PET-CT imaging. [13][14][15] Conventional MPI identifies local reductions in perfusion relative to the best ventricular wall, where the maximum value is presumed to be normal.…”