Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy

Abstract

BackgroundStress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data.MethodsAll 4,820 patients who underwent 99mTc MPS at Skåne University Hospital in Malmö, Sweden, in 2004 to 2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin.ResultsA total of 3,426 patients with a normal perfusion study were included. Of these, 2,215 patients had a stress-only study and 1,211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p < 0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p < 0.0001 for all comparisons). Regarding left ventricular function data, we did not find any significant difference in event rate between normal vs. abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF, and EDV vs. abnormal EF or EDV for either the normal stress-only patients or the normal stress-rest patients.ConclusionsPatients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.

Effect of a patient-specific minimum activity in stress myocardial perfusion imaging using CZT-SPECT: Prognostic value, radiation dose, and scan outcome

“…They report annual hard cardiac event rates varying between 0.6 and 1.3% for normally interpreted stress-only scans and between 1.2 and 1.4% for normally interpreted stress-rest scans. [32][33][34][35] These rates seem slightly higher than encountered in the present study which could be due to differences in the pre-test likelihood and the use of conventional instead of CZT-based SPECT cameras.…”

High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

“…The MPI tests were performed on clinical grounds in all patients, hence these tests followed the clinical procedure and guidelines 20 21 implemented at the Department of Clinical Physiology and Nuclear Medicine at Skåne University Hospital in Malmö, Sweden. The protocol, which has been previously described in detail, 22 included provocation with either exercise on a bicycle or pharmacological provocation with adenosine or regadenosone, after which 99m Tc-tetrofosmin was injected and corresponding coronary perfusion images were acquired by single-photon emission CT (SPECT). Images were obtained according to established clinical protocols, using SPECT and dual-head gamma camera (Siemens AG Medical Solutions, Erlangen, Germany) with attenuation correction.…”

The diagnostic efficacy and safety of stress-only supine and prone myocardial perfusion imaging with a dedicated cardiac gamma camera in patients with suspected or known coronary artery disease

“…Słomka et al indicated the improved diagnostic accuracy of myocardial perfusion imaging with Original conventional gamma cameras and two-position prone-supine protocol by resolving of subtle attenuation artifacts [1]. Edenbrandt et al reported 6-year cardiac event rate lower than 1% in patients with normal stress SPECT on a large number of patients [2]. However, in this study different scanner (conventional dual-detector gamma camera), radiopharmaceutical and stress protocols were employed.…”