title: Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction.
abstract: BACKGROUND
  We evaluated the incremental prognostic value of viability assessment by nitrate single-photon emission computed tomography (SPECT) in patients with ischemic left ventricular (LV) dysfunction.
  
  
  RESULTS
  One hundred and sixty-four patients with previous myocardial infarction and LV dysfunction (ejection fraction 29% +/- 15%) underwent two Tc-99m sestamibi SPECT studies, under control conditions and after sublingual nitrate administration, for evaluation of myocardial viability. In each patient, viability was defined as the presence of > or = 2 severely dysfunctional segments with preserved tracer uptake (> or = 55% of peak activity). Cardiac death, myocardial infarction, and late (> 2 months) revascularization were considered events. Follow-up was 98% complete at a mean period of 30 +/- 24 months. At baseline SPECT, 119 (73%) patients had evidence of viable myocardium, while 45 (27%) did not. Of these latter patients, 18 (40%) had evidence of viability after nitrate administration. Cardiac events occurred in 58 (35%) patients. Cumulative probability of event-free survival was similar in patients with and without viability at baseline SPECT (log rank 0.3, P = NS), while it was lower in patients with viability at nitrate SPECT compared to those without (log rank 6.3, P < .01). The addition of nitrate SPECT data significantly improved the prognostic power of the model including clinical, functional, angiographic, and baseline SPECT data (P < .01).
  
  
  CONCLUSIONS
  In patients with previous myocardial infarction and LV dysfunction, nitrate SPECT imaging provides incremental prognostic information over those obtained from clinical, functional, angiographic variables, and baseline SPECT data.
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Evangelista
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.forename: Adele
authors.initials: A
authors.lastname: Ferro
authors.forename: Francesca
authors.initials: F
authors.lastname: Ricci
authors.forename: Luca
authors.initials: L
authors.lastname: Luongo
authors.forename: Stefania
authors.initials: S
authors.lastname: Daniele
authors.forename: Giorgio
authors.initials: G
authors.lastname: Punzo
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality*; D009566:Nitrates; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
chemical_list: D009566:Nitrates; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi