Gated myocardial perfusion SPECT for preoperative risk stratification in patients with noncardiac vascular disease.
OBJECTIVE
Myocardial perfusion single photon emission computed tomography (SPECT) is useful for preoperative cardiac risk stratification. We investigated the value of preoperative pharmacologic stress electrocardiographic (ECG)-gated myocardial perfusion SPECT for noncardiac vascular surgery.


METHODS
To assess the perioperative cardiac risk for noncardiac vascular surgery, preoperative pharmacologic stress ECG-gated myocardial perfusion SPECT was performed in 211 consecutive patients who underwent noncardiac aortic surgery. We examined myocardial perfusion and left ventricular function by the quantitative gated SPECT (QGS), and the correlation with perioperative cardiac events was investigated.


RESULTS
Perioperative cardiac events occurred in 9 of 211 patients (4.3%). On the basis of univariate analysis, significant predictors for preoperative cardiac risk stratification included history of heart failure (P < 0.05), history of coronary artery revascularization (P < 0.05), summed stress score (SSS) (P < 0.0001), summed rest score (SRS) (P < 0.005), SSS > or = 7 (P < 0.005), end-diastolic volume (EDV) > or = mean + 2 standard deviation (SD) (134 ml for men and 93 ml for women) (P < 0.005), end-systolic volume (ESV) > or = mean + 2 SD (60 ml for men and 37 ml for women) (p < 0.0001), left ventricular ejection fraction (EF) < or = mean - 2 SD (48% for men and 55% for women) (P < 0.005) and wall motion abnormality (P < 0.05). On the basis of multivariate analysis, ESV > or = mean + 2 SD was the only independent predictor for perioperative cardiac events (P < 0.005).


CONCLUSIONS
Pharmacologic stress ECG-gated myocardial perfusion SPECT, which permits assessment of both myocardial perfusion and cardiac function, is useful for preoperative risk stratification of noncardiac vascular surgery.
Kayano
Daiki
D
Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan. kayano@nmd.m.kanazawa-u.ac.jp
Nakajima
Kenichi
K
Ohtake
Hiroshi
H
Kinuya
Seigo
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*