Prediction of new-onset refractory congestive heart failure using gated myocardial perfusion SPECT imaging in patients with known or suspected coronary artery disease subanalysis of the J-ACCESS database.
OBJECTIVE
The purpose of this study was to evaluate the predictive value of perfusion/function parameters measured by gated myocardial perfusion single-photon emission computed tomography (SPECT)in combination with clinical variables in patients with known or suspected coronary artery disease to predict refractory heart failure (HF).


BACKGROUND
The increasing number of HF patients requires the establishment of a prophylactic strategy that can identify patients at high risk of HF due to coronary artery disease.


METHODS
We analyzed clinical and stress/rest-gated SPECT data from the multicenter, prospective, and observational J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) database of 3,835 known or suspected coronary artery disease patients in which new-onset congestive HF symptoms requiring aggressive medical treatment were observed in 71 patients for 3 years.


RESULTS
The multivariable Cox hazard model revealed that chronic renal dysfunction (hazard ratio(HR): 6.227 [95% confidence interval (CI): 2.920 to 13.279]), the end-systolic volume index (ESVI) (HR:1.019 [95% CI: 1.011 to 1.029]), and moderate to high stress summed score (SSS) (HR: 3.012 [95% CI: 1.757 to 5.181]) independently (p < 0.0001) predicted HF. In addition to the close (p < 0.0001) correlation of ESVI and SSS with HF incidence, the combined tertiles of SSS and ESVI revealed high-risk patients with a maximally 17.3 times greater risk (5.2%/3 years) compared with the minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI. Chronic renal dysfunction combined with ESVI and SSS categories had the greatest (p < 0.005 to 0.001) incremental prognostic value with a global chi-square value (125.0)over single or other combined risks.


CONCLUSIONS
Chronic renal dysfunction, greater stress-induced perfusion abnormality, and higher ESVI provide independent and additive information for predicting the risk of refractory HF in known or suspected coronary patients, indicating the efficacy of perfusion/function parameters measured by stress gated perfusion SPECT for identifying patients at greater risk of future refractory HF.
Nakata
Tomoaki
T
Hashimoto
Akiyoshi
A
Wakabayashi
Takeru
T
Kusuoka
Hideo
H
Nishimura
Tsunehiko
T
D000255:Adenosine Triphosphate; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation; D019992:Databases as Topic; D004176:Dipyridamole; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
D004176:Dipyridamole; D000255:Adenosine Triphosphate