Poststress left ventricular ejection fraction is an independent predictor of major cardiac events in patients with coronary artery disease and impaired left ventricular function.
OBJECTIVE
The aim of this study was to investigate the prognostic value of myocardial perfusion and function SPECT imaging in patients with coronary artery disease (CAD) and poor left ventricular (LV) function.


METHODS
We studied 261 patients (231 men, age 66+/-10 years) with CAD and a resting LV ejection fraction (LVEF) <or= 40% assessed during myocardial gated SPECT. Perfusion defect extent was calculated using 4D-MSPECT software (Michigan University). Ischemia scoring was performed visually. Considered end points were: 1) major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction or late revascularization), 2) MACE or the need for hospitalization due to heart failure (MACE-HF) and 3) cardiac death or non-fatal myocardial infarction.


RESULTS
During a median follow-up of 31 months, 52 patients (20%) died (35 cardiac deaths), 50 (19%) developed a MACE and 69 (26%) a MACE-HF. In a clinical model, diabetes and angina status were the only predictors of MACE (chi-squared=19.3; P<0.001). By multivariate analysis, poststress LVEF (chi-squared-gain of 6.4; P=0.008) and presence of ischemia (chi-squared-gain of 5.8; P=0.018) were predictive of MACE. Similarly, diabetes mellitus (chi-squared=12.1; P<0.001), poststress LVEF (chi-squared-gain of 5.5; P=0.019) and presence of ischemia (chi-squared-gain of 4.3; P=0.044) were independent predictors of MACE-HF. Diabetes mellitus (chi-squared=17.8; P<0.001), presence of angina complaints (chi-squared-gain of 6.8; P=0.028) and poststress LVEF (chi-squared-gain of 6.3; P=0.008) were independent predictors of cardiac death or non-fatal myocardial infarction.


CONCLUSIONS
In patients with impaired LV function and CAD, poststress LVEF is an independent predictor of future cardiac events.
De Winter
O
O
Nuclear Medicine Division, Ghent University Hospital Ghent, Belgium. olivier.dewinter@UGent.be
Van De Veire
N
N
De Bondt
P
P
Van De Wiele
C
C
De Buyzere
M
M
De Backer
G
G
Gillebert
T C
TC
Dierckx
R A
RA
De Sutter
J
J
D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D003326:Coronary Circulation; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010477:Perfusion; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis*; D016277:Ventricular Function, Left