title: Relationship of technetium-99m tetrofosmin-gated rest single-photon emission computed tomography myocardial perfusion imaging to death and hospitalization in heart failure patients: results from the nuclear ancillary study of the HF-ACTION trial.
abstract: BACKGROUND
  We hypothesized that the severity of resting perfusion abnormalities assessed by the summed rest score (SRS) would be associated with a higher rate of adverse outcomes in patients with heart failure (HF) and reduced left ventricular (LV) ejection fraction (EF).
  
  
  METHODS
  A subset of 240 subjects from HF-ACTION underwent resting technetium-99m tetrofosmin-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Images were evaluated using a 17-segment model to derive the SRS and additional nuclear variables.
  
  
  RESULTS
  After adjusting for prespecified covariates, SRS was significantly associated with the primary end point (hazard ratio 0.98, 95% confidence interval [CI] 0.97-1.00, P = .04), with a higher SRS corresponding to lower risk of an event. This association was not present in the unadjusted analysis. The relationship between SRS and the primary outcome was likely due to a higher event ratein patients with ischemic HF and a low SRS. The LV phase SD was not predictive of the primary outcome (hazard ratio 1.00, 95% confidence interval 0.99-1.01, P = .49). In a post hoc analysis, nuclear variables provided incremental prognostic information when added to clinical information (P = .006).
  
  
  CONCLUSIONS
  Gated SPECT MPI provides important information in patients with HF and reduced LVEF. In the adjusted analysis, SRS has an unexpected relationship with the primary end point. Phase SD was not associated with the primary end point. Rest-gated SPECT MPI provides incrementally greater prognostic information than clinical information alone.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Allen E
authors.initials: AE
authors.lastname: Atchley
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Dan
authors.initials: D
authors.lastname: Bensimhon
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pagnanelli
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.forename: Andrew
authors.initials: A
authors.lastname: Kao
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdul-Nour
authors.forename: Greg
authors.initials: G
authors.lastname: Ewald
authors.forename: Mary Norine
authors.initials: MN
authors.lastname: Walsh
authors.forename: William E
authors.initials: WE
authors.lastname: Kraus
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin