title: Left Ventricular Energy Model Predicts Adverse Events in Women With Suspected Myocardial Ischemia: Results From The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study.
abstract: OBJECTIVE
  To assess the prognostic value of a left ventricular energy-model in women with suspected myocardial ischemia.
  
  
  BACKGROUND
  The prognostic value of internal energy utilization (IEU) of the left ventricle in women with suspected myocardial ischemia is unknown.
  
  
  METHODS
  Women (n=227, mean age 59±12 years, range 31-86), with symptoms of myocardial ischemia, underwent myocardial perfusion imaging (MPI) assessment for regional perfusion defects along with measurement of ventricular volumes separately by gated Single Photon Emission Computed Tomography (SPECT) (n= 207) and magnetic resonance imaging (MRI) (n=203). During follow-up (40±17 months), time to first major adverse cardiovascular event (MACE, death, myocardial infarction or hospitalization for congestive heart failure) was analyzed using MRI and gated SPECT variables.
  
  
  RESULTS
  Adverse events occurred in 31 (14%). Multivariable Cox models were formed for each modality: IEU and wall thickness by MRI (Chi-squared 34, p<0.005) and IEU and systolic blood pressure by gated SEPCT (Chi-squared 34, p<0.005). The models remained predictive after adjustment for age, disease history and Framingham risk score. For each Cox model, patients were categorized as high-risk if the model hazard was positive and not high-risk otherwise. Kaplan-Meier analysis of time to MACE was performed for high-risk vs. not high-risk for MR (log rank 25.3, p<0.001) and gated SEPCT (log rank 18.2, p<001) models.
  
  
  CONCLUSIONS
  Among women with suspected myocardial ischemia a high internal energy utilization has higher prognostic value than either a low EF or the presence of a myocardial perfusion defect assessed using two independent modalities of MR or gated SPECT.
authors.affiliation: Allegheny General Hospital, Pittsburgh, PA.
authors.forename: Mark
authors.initials: M
authors.lastname: Doyle
authors.forename: Nicole
authors.initials: N
authors.lastname: Weinberg
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Pohost
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Anthon
authors.initials: A
authors.lastname: Fuisz
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Edward G
authors.initials: EG
authors.lastname: Walsh
authors.forename: B Delia
authors.initials: BD
authors.lastname: Johnson
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Sunil
authors.initials: S
authors.lastname: Mankad
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
authors.forename: Geetha
authors.initials: G
authors.lastname: Rayarao
authors.forename: Diane A
authors.initials: DA
authors.lastname: Vido
authors.forename: Vera
authors.initials: V
authors.lastname: Bittner
authors.forename: Lindsey
authors.initials: L
authors.lastname: Tauxe
authors.forename: Marian B
authors.initials: MB
authors.lastname: Olson
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Robert Ww
authors.initials: RW
authors.lastname: Biederman
keywords: Hypertension; MRI Scans; Myocardial Ischemia; SPECT