title: The additive prognostic value of perfusion and functional data assessed by quantitative gated SPECT in women.
abstract: BACKGROUND
  The aim of this study was to assess the prognostic value of technetium-99m tetrofosmin gated SPECT imaging in women using quantitative gated single photon emission computed tomography (SPECT) imaging.
  
  
  METHODS
  We followed 453 consecutive female patients. Average follow-up was 1.33 years (max. 2.55). Hard endpoints were cardiac death, acute myocardial infarction, or documented ventricular fibrillation. Event-free survival curves were obtained. Optimal cutoff values for left ventricular (LV) volumes, LV ejection fraction (LVEF), and perfusion data to predict outcome were determined by ROC curve analysis.
  
  
  RESULTS
  A total of 236 patients had an abnormal study, of whom 27 patients experienced hard events (16 deaths) and 47 patients soft events. For hard events summed stress score (SSS) and LVEF, and for any cardiac event SSS showed independent incremental prognostic value. The survival curves were maximally separated when using cutoff values for SSS of > or = 22 and LVEF < 52% (P < 0.001, HR 4.61 and P < 0.001 HR 5.24 for SSS and LVEF resp.), and SSS > or = 14 (P < 0.001 HR 3.76) for any cardiac event.
  
  
  CONCLUSIONS
  In women, perfusion and functional parameters derived from quantitative gated technetium-99m tetrofosmin SPECT imaging can adequately be used for cardiac risk assessment. Using quantitative gated SPECT, female patients with an LVEF < 52% or an SSS > or = 22 are at increased risk for subsequent hard events. Furthermore, patients with an SSS > or = 14 are at increased risk for any cardiac events.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
authors.forename: Yves G C J
authors.initials: YG
authors.lastname: America
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Marcel
authors.initials: M
authors.lastname: Stokkel
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000706:statistics & numerical data*