Etiology and pathophysiology of new-onset heart failure: evaluation by myocardial perfusion imaging.
OBJECTIVE
The IMAGING in Heart Failure study was a prospective, multi-national trial designed to explore the role of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) as an initial investigative strategy in patients hospitalized with new-onset heart failure.


METHODS
We recruited 201 patients (age 65.3 +/- 14.5 years, 43% women) hospitalized with their first episode of heart failure. Rest/stress gated SPECT Tc-99m sestamibi MPI was performed during or within 2 weeks of the index hospitalization, in addition to standard care.


RESULTS
SPECT MPI revealed a broad range of ejection fractions with preserved systolic function in 36% of patients. Forty-one percent of patients had normal perfusion. In the remaining patients, perfusion abnormalities were predominantly due to prior myocardial infarction, with extensive ischemia seen only in 6%. Among patients who underwent coronary angiography, SPECT performance characteristics revealed excellent negative predictive value (96%) for extensive coronary artery disease (CAD). In multivariable analyses, the extent of perfusion abnormality and advancing age predicted the presence of extensive CAD.


CONCLUSIONS
These preliminary data derived from a non-randomized observational cohort suggest potential diagnostic utility of MPI for ischemic LV dysfunction in new-onset HF, and sets the stage for a prospective randomized study to confirm these findings.
Soman
Prem
P
Nuclear Cardiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USA. somanp@upmc.edu
Lahiri
Avijit
A
Mieres
Jennifer H
JH
Calnon
Dennis A
DA
Wolinsky
David
D
Beller
George A
GA
Sias
Tina
T
Burnham
Kenneth
K
Conway
Laurence
L
McCullough
Peter A
PA
Daher
Edouard
E
Walsh
Mary N
MN
Wight
Joseph
J
Heller
Gary V
GV
Udelson
James E
JE
D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi