title: Myocardial perfusion imaging in patients with a recent, normal exercise test.
abstract: OBJECTIVE
  To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG).
  
  
  METHODS
  This study was a retrospective analysis of consecutive patients referred for MPI during a 2-year period from 2006-2007 at one clinic. All eligible patients were suspected of suffering from CAD, and had performed a satisfactory bicycle exercise test (i.e., peak heart rate > 85% of the expected, age-predicted maximum) within 6 mo of referral, their exercise ECG was had no signs of ischemia, there was no exercise-limiting angina, and no cardiac events occurred between the exercise test and referral. The patients subsequently underwent a standard 2-d, stress-rest exercise MPI. Ischemia was defined based on visual scoring supported by quantitative segmental analysis (i.e., sum of stress score > 3). The results of cardiac catheterization were analyzed, and clinical follow up was performed by review of electronic medical files.
  
  
  RESULTS
  A total of 56 patients fulfilled the eligibility criteria. Most patients had a low or intermediate ATPIII pre-test risk of CAD (6 patients had a high pre-test risk). The referral exercise test showed a mean Duke score of 5 (range: 2 to 11), which translated to a low post-exercise risk in 66% and intermediate risk in 34%. A total of seven patients were reported with ischemia by MPI. Three of these patients had high ATPIII pre-test risk scores. Six of these seven patients underwent cardiac catheterization, which showed significant stenosis in one patient with a high pre-test risk of CAD, and indeterminate lesions in three patients (two of whom had high pre-test risk scores). With MPI as a gate keeper for catheterization, no significant, epicardial stenosis was observed in any of the 50 patients (0%, 95% confidence interval 0.0 to 7.1) with low to intermediate pre-test risk of CAD and a negative exercise test. No cardiac events occurred in any patients within a median follow up period of > 1200 d.
  
  
  CONCLUSIONS
  The added diagnostic value of MPI in patients with low or intermediate risk of CAD and a recent, normal exercise test is marginal.
authors.affiliation: Ann Bovin, Department of Clinical Physiology, Viborg Hospital, DK-8800 Viborg, Denmark.
authors.forename: Ann
authors.initials: A
authors.lastname: Bovin
authors.forename: Ib C
authors.initials: IC
authors.lastname: Klausen
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Petersen
keywords: Added value; Exercise electrocardiography; Ischemic heart disease; Myocardial perfusion imaging; Post-test risk; Pre-test risk; Single photon emission tomography
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