title: Prognostic value of combined perfusion and function by stress technetium-99m sestamibi gated SPECT myocardial perfusion imaging in patients with suspected or known coronary artery disease.
abstract: The incremental prognostic value of combined regional wall motion and perfusion over perfusion alone by gated single-photon emission computed tomographic myocardial perfusion scintigraphy has not been evaluated. Of the 402 consecutive patients who underwent stress single-photon emission computed tomographic myocardial perfusion scintigraphy for suspected myocardial ischemia, we identified 333 patients (217 men, mean age 63 +/- 10 years; exercise in 249 and dipyridamole adminstered to 84). Visual scoring of perfusion images and regional wall motion used 20 segments and a scale of 0 to 4. Resting and poststress left ventricular ejection fraction was automatically generated. On follow-up (median 13 months), 30 hard cardiac events (17 cardiac deaths, 13 nonfatal acute myocardial infarctions) and 66 total cardiac events (including hard events, 26 with unstable angina, and 10 who underwent late revascularization) occurred. After adjustment for prescan information, the best independent predictors of hard events were summed stress score for wall motion (Wald's chi-square 8.3, p <0.004) and several vascular territories with ischemia by perfusion/function (Wald's chi-square 6.2, p <0.01). The strongest predictors of all cardiac events were the number of ischemias (Wald's chi-square 32.1, p <0.0001) and the number of ischemic vascular territories by perfusion (Wald's chi-square 13.1, p <0.0001). Addition of function data to the combined model of perfusion data yielded an incremental value of 26% for predicting hard events but not for all events. In conclusion, the assessment of combined perfusion/function provides incremental prognostic information for further hard events with perfusion data alone; perfusion data best predict all cardiac events.
authors.affiliation: Department of Nuclear Medicine, Misericordia e Dolce Hospital, Prato, Italy. npetix@hotmail.com
authors.forename: Nunzia Rosa
authors.initials: NR
authors.lastname: Petix
authors.forename: Stelvio
authors.initials: S
authors.lastname: Sestini
authors.forename: Angela
authors.initials: A
authors.lastname: Coppola
authors.forename: Gabriella
authors.initials: G
authors.lastname: Marcucci
authors.forename: Franco
authors.initials: F
authors.lastname: Nassi
authors.forename: Andrea
authors.initials: A
authors.lastname: Taiti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guarnaccia
authors.forename: Alberto
authors.initials: A
authors.lastname: Mennuti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Zipoli
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi