Prognostic implications of normal exercise tomographic thallium images in patients with angiographic evidence of significant coronary artery disease

The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography

“…Among these, 148 full-text articles evaluating the prognostic utility of exercise MPI or exercise echocardiography were reviewed, and 20 studies were found to be eligible for the systematic review. Of the 148 full-text articles reviewed, 17 did not address the research question (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), 18 were excluded because they used pharmacologic rather than exercise stress (32-49), 27 did not include primary data on event rates that could be combined in a meta-analysis (47,50 -75), 16 did not address a population with known or suspected CAD (76 -91), 5 evaluated only hospitalized patients or patients evaluated for chest pain syndromes in the emergency department (92)(93)(94)(95)(96), 16 included only patients with angiographically proven CAD or positive tests (97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112), 21 were potentially overlapping patient populations of other studies (53,(113)(114)(115)…”

Value of Stress Myocardial Perfusion Single Photon Emission Computed Tomography in Patients With Normal Resting Electrocardiograms

“…Although angiographic and stress perfusion measure different characteristics of the same disease, the latter is a physiological measure that, unlike angiographic data, closely agrees with flow reserve and thus also reflects the vasomotor component medicated by endothelial function 21 (eg, abnormalities in the setting of hemodynamically significant stenoses that seem anatomically quiescent). Hence, a normal stress perfusion study is associated with a low risk even in the setting of multivessel CAD, 22,23 and SPECT is predictive of both cardiac death and MI. 6 Thus, the differences between the present and previous studies may be attributable to stress SPECT being better suited as a prognostic than anatomic measure, thus having measurably superior performance characteristics and costeffectiveness for predicting outcomes than anatomic end points.…”

The Role of Nuclear Cardiology in the Diagnosis and Risk Stratification of Women With Ischemic Heart Disease

“…86 This extremely low risk also applies to patients with abnormalities on treadmill ECG testing as severe as an intermediate Duke treadmill score, 87,88 as well as to patients with anatomical disease on ICA. 89,90 At the same time, abnormal perfusion images increase risk even in the absence of significant CAD. 91 Both the extent and severity of perfusion abnormalities increase the risk of a cardiac event, 92 often expressed on SPECT imaging as summed scores, that is, summed stress score (SSS), summed rest score, and the summed difference score between stress and rest images.…”