title: Prognostic value of stress-only and stress-rest normal gated SPECT imaging: higher incidence of cardiac hard events in diabetic patients who underwent full stress-rest imaging.
abstract: BACKGROUND
  The European procedural guidelines for cardiac gated SPECT imaging demonstrate considerable variability in recommended administered radiopharmaceutical activity and imaging protocols. This study compared stress-only and stress-rest protocols to evaluate the safety of stress-only imaging, and to identify characteristics of patients who need full stress-rest imaging.
  
  
  METHODS
  Patients referred for a chest pain were scheduled for stress-rest gated SPECT imaging. If the stress images were interpreted as normal according to the perfusion and left ventricular function, the examination of patients was finished and patients did not undergo the rest imaging. A total number of 1063 patients was included (mean age 61 ± 11 years). These patients have been followed for hard cardiac events, i.e. cardiac deaths or nonfatal myocardial infarction.
  
  
  RESULTS
  During a follow-up of 3.2 ± 2.5 years, hard events occurred in 12 patients with normal SPECT and 59 with abnormal SPECT had hard events (0.7 vs. 3.6% /year, P < 0.001). Among the 536 patients with normal study, there was no significantly lower incidence of hard events in the subgroup of patients with stress-only imaging (0.6 vs. 0.8% /year, P = 0.641). Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT (1.3 vs. 0.5%/year, P < 0.001). We found a higher incidence of hard events in diabetic patients with normal study with the necessity of full stress-rest imaging in comparison with those with stress-only imaging (1.7 vs. 0.7% /year, P < 0.001).
  
  
  CONCLUSIONS
  Our results support the good prognosis of normal stress-only study. Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT. Diabetic patients with normal results who required additional rest imaging had significant adverse outcome.
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Kaminek
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Iva
authors.initials: I
authors.lastname: Metelkova
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Budikova
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Henzlova
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Koranda
authors.affiliation: International Clinical Research Center, Centrum of Molecular Imaging, Brno.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kincl
authors.affiliation: International Clinical Research Center, Centrum of Molecular Imaging, Brno.
authors.forename: Adela
authors.initials: A
authors.lastname: Drozdova
mesh_terms: D018153:Czech Republic / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
keywords: coronary artery disease; diabetes mellitus; myocardial perfusion imaging; prognosis; stress-only imaging