title: Dipyridamole thallium-201 single-photon emission computed tomography for prediction of perioperative cardiac events in patients with arteriosclerosis obliterans undergoing vascular surgery.
abstract: The aim of the study was to determine whether or not dipyridamole thallium-201 single-photon emission computed tomography (201Tl-SPECT) has significant additive value for predicting perioperative cardiac events in patients with arteriosclerosis obliterans (ASO) undergoing vascular surgery. Routine preoperative 201Tl-SPECT was performed in 106 consecutive patients with ASO (age 68+/-8.9 years; 91 men and 15 women). The frequency of reversible defects in a clinical high-risk group (n=44) was significantly higher than in a low-risk group (n=62; 55% vs 24%, p<0.01). Perioperative cardiac events occurred in 9 patients, including 4 cardiac deaths, 1 non-fatal myocardial infarction, and 4 cases of unstable angina. Although clinical risk stratification was useful in predicting cardiac events (19% in the high-risk group vs 2% in the low-risk group, p<0.01), the positive predictive value was low. When considering a combination of 2 or more than 2 risk factors and a large reversible defect as a predictor, the positive predictive value and specificity increased from 19% to 47% and from 64% to 91%, respectively, whereas the sensitivity remained unchanged (89%). These results suggest that the addition of 201Tl-SPECT data to clinical risk-stratified patients with ASO allows better prediction of perioperative cardiac events.
authors.affiliation: Second Department of Medicine, Yamanashi Medical University, Nakakoma, Japan.
authors.forename: Z
authors.initials: Z
authors.lastname: Huang
authors.forename: S
authors.initials: S
authors.lastname: Komori
authors.forename: T
authors.initials: T
authors.lastname: Sawanobori
authors.forename: I
authors.initials: I
authors.lastname: Kohno
authors.forename: S
authors.initials: S
authors.lastname: Sano
authors.forename: T
authors.initials: T
authors.lastname: Ishihara
authors.forename: K
authors.initials: K
authors.lastname: Umetani
authors.forename: H
authors.initials: H
authors.lastname: Ijiri
authors.forename: K
authors.initials: K
authors.lastname: Koizumi
authors.forename: T
authors.initials: T
authors.lastname: Araki
authors.forename: K
authors.initials: K
authors.lastname: Kamiya
authors.forename: Y
authors.initials: Y
authors.lastname: Tada
authors.forename: K
authors.initials: K
authors.lastname: Tamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D004176:Dipyridamole / Q000008:administration & dosage; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011859:Radiography; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D004176:Dipyridamole