Incremental prognostic value of combined perfusion and function assessment during myocardial gated SPECT in patients aged 75 years or older.
BACKGROUND
Perfusion and functional data obtained during gated single photon emission computed tomography (SPECT) have proven prognostic value in the middle-aged patient population. The aim of this study was to investigate whether perfusion and functional cardiac gated SPECT data have prognostic value in patients aged 75 years or older.


RESULTS
We studied clinical and gated SPECT predictors of cardiac and all-cause death in 294 patients aged 75 years or older with known or suspected coronary artery disease who were referred for tetrofosmin cardiac gated SPECT imaging. Summed perfusion scores were calculated in a 17-segment model by use of commercially available software (4D-MSPECT). Left ventricular functional data were calculated by use of QGS gated SPECT software. The median age of the study population was 78 years (range, 75-91 years). There were 160 men (54%) and 134 women (46%). During a median follow-up of 25.9 months (range, 1.8-36 months), 47 patients (16%) died (27 cardiac deaths). In a multivariate Cox proportional hazards regression analysis, the summed rest score (chi2 gain = 8.0, P = .009), transient ischemic dilatation index (chi2 gain = 6.3, P = .012), and resting left ventricular ejection fraction (chi2 gain = 7.0, P = .030) were independent predictors of all-cause death. The summed rest score (chi2 gain = 8.2, P = .004) and resting end-systolic volume (chi2 gain = 13.7, P = .005) were independent predictors of cardiac death.


CONCLUSIONS
This study showed that gated SPECT left ventricular functional data assessed during myocardial gated SPECT provide independent and incremental information above clinical and perfusion SPECT data for the prediction of cardiac and all-cause death in patients aged 75 years or older referred for myocardial SPECT imaging.
De Winter
Olivier
O
Nuclear Medicine Division, Ghent University Hospital, Ghent, Belgium. olivier.dewinter@UGent.be
Velghe
Anja
A
Van de Veire
Nico
N
De Bondt
Pieter
P
De Buyzere
Marc
M
Van De Wiele
Christophe
C
De Backer
Guy
G
Gillebert
Thierry C
TC
Dierckx
Rudi A
RA
De Sutter
Johan
J
D000368:Aged; D001530:Belgium / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D003326:Coronary Circulation; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*