title: Prognostic value of post-ischemic stunning as assessed by gated myocardial perfusion single-photon emission computed tomography: a subanalysis of the J-ACCESS study .
abstract: BACKGROUND
  To determine the prognostic value of post-ischemic stunning, the Japanese assessment of cardiac event and survival study by quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) study was reevaluated.
  
  
  RESULTS
  Of the 4,031 patients of the J-ACCESS, the present study evaluated 1,089 who completed gated SPECT both after stress and at rest. To assess post-ischemic stunning, the following measurements (left ventricular volumes after stress minus volumes at rest) were made: Deltaend-systolic volume (DeltaESV), Deltaenddiastolic volume (DeltaEDV) and Deltaejection fraction (DeltaEF). Myocardial stunning defined either as DeltaESV >or=5 ml, DeltaEDV >or=5 ml or DeltaEF <or=5% was observed in 21%, 22%, or 26%, respectively. During a 3-year follow-up, 101 cardiac events occurred. Kaplan-Meier survival estimation indicated worse event-free survival rates in patients with dilated ESV, dilated EDV, LVEF <or=45%, DeltaESV >or=5 ml or DeltaEDV >or=5 ml than in those without, whereas DeltaEF <or=5% did not predict events. Multivariate analysis demonstrated that LVEF <or=45% was the independent predictor for cardiac events. Nevertheless, DeltaEDV >or=5 ml was also an independent parameter, in addition to LVEF <or=45%, to predict the combined endpoint of cardiac death, myocardial infarction, and revascularization, but excluding heart failure.
  
  
  CONCLUSIONS
  These results indicate that post-ischemic stunning, as assessed by gated SPECT, is a marker for poor prognosis, particularly for ischemic cardiac events.
authors.affiliation: Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Usui
authors.forename: Taishiro
authors.initials: T
authors.lastname: Chikamori
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hida
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000473:pathology*; D017682:Myocardial Stunning / Q000175:diagnosis*; D011379:Prognosis; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*