Prognostic value of quantitative high-speed myocardial perfusion imaging.
BACKGROUND
We studied the prognostic value of fully automated quantitative analysis software applied to new solid-state, high-speed (HS) SPECT-myocardial perfusion imaging (MPI).


METHODS
1,613 consecutive patients undergoing exercise or adenosine HS-MPI were followed for 2.6 ± 0.5 years for all-cause mortality (ACM). Automated quantitative software was used to compute stress total perfusion deficit (sTPD) and was compared to semi-quantitative visual analysis. MPI was characterized as 0% (normal), 1%-4% (minimal perfusion defect), 5%-10% (mildly abnormal), and >10% (moderately/severely abnormal).


RESULTS
During follow-up, 79 patients died (4.9%). Annualized ACM increased with progressively increasing sTPD; 0% (0.87%), 1%-4% (1.94%), 5%-10% (3.10%), and >10% (5.33%) (log-rank P < .0001). While similar overall findings were observed with visual analysis, only sTPD demonstrated increased risk in patients with minimal perfusion defects. In multivariable analysis, sTPD > 10% was a mortality predictor (HR 3.03, 95% CI 1.30-7.09, P = .01). Adjusted mortality rate was substantial in adenosine MPI, but low in exercise MPI (9.0% vs 1.0%, P < .0001).


CONCLUSIONS
By quantitative analysis, ACM increases with increasing perfusion abnormality among patients undergoing stress HS-MPI. These findings confirm previous results obtained with visual analysis using conventional Anger camera imaging systems.
Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Taper Building Suite 1258, Los Angeles, CA 90048, USA.
Ryo
R
Nakazato
Daniel S
DS
Berman
Heidi
H
Gransar
Mark
M
Hyun
Romalisa
R
Miranda-Peats
Faith C
FC
Kite
Sean W
SW
Hayes
Louise E J
LE
Thomson
John D
JD
Friedman
Alan
A
Rozanski
Piotr J
PJ
Slomka
D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D019275:Radiopharmaceuticals; D000241:Adenosine