title: Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes.
abstract: BACKGROUND
  Whether there are gender differences in the prognostic application of gated myocardial perfusion single photon emission computed tomography (SPECT) has not been assessed.
  
  
  RESULTS
  Gender-specific normal limits of poststress volume and ejection fraction (EF) were obtained in 597 women and 824 men with a low likelihood of coronary artery disease and normal perfusion and were applied in a prognostic evaluation of 6713 patients (2735 women and 3978 men). Patients underwent rest thallium-201/stress technetium-99m sestamibi gated myocardial perfusion SPECT and were followed up for 35 +/- 14 months. The upper limit of the end-systolic volume (ESV) index was 27 mL/m2 in women and 39 mL/m2 in men, and the upper limit of the end-diastolic volume index was 60 mL/m2 in women and 75 mL/m2 in men. The lower limit of the EF was 51% in women and 43% in men. Gated SPECT variables provided incremental prognostic information in both genders. Women with severe ischemia and an EF lower than 51% or an ESV index greater than 27 mL/m2 were at very high risk of cardiac death or myocardial infarction (3-year event rates of 39.8% and 35.1%, respectively), whereas women with severe ischemia but an EF of 51% or greater or an ESV index of 27 mL/m2 or less were at intermediate or high risk (3-year event rates of 10.8% and 15.2%, respectively).
  
  
  CONCLUSIONS
  Poststress EF and ESV index by gated myocardial perfusion SPECT provide comparable incremental prognostic information over perfusion in women and men. After separate criteria for abnormal EF and ESV index in women are used, the combination of severe ischemia and abnormal EF or ESV index identifies women at very high risk of cardiac events.
authors.affiliation: Department of Imaging, Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048, USA.
authors.forename: Tali
authors.initials: T
authors.lastname: Sharir
authors.forename: Xingping
authors.initials: X
authors.lastname: Kang
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.forename: Ishac
authors.initials: I
authors.lastname: Cohen
authors.forename: Sean W
authors.initials: SW
authors.lastname: Hayes
authors.forename: John D
authors.initials: JD
authors.lastname: Friedman
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
mesh_terms: D000368:Aged; D015897:Comorbidity; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*