title: Outcome of patients with high-risk Duke treadmill score and normal myocardial perfusion imaging on spect.
abstract: Annual mortality rate can range from <1% for patients with normal myocardial perfusion by SPECT to >5% based on a high-risk Duke treadmill score (DTS). Information on the prognosis of patients with the combination of HRDTS and normal SPECT is limited and is the purpose of this study.
  
  
  
  Data from a large nuclear cardiology registry (n = 17,972 patients) were reviewed. A total of 340 had HRDTS (score ≤ -11) while undergoing SPECT. Combined cardiovascular mortality and non-fatal myocardial infarction (MI) and cardiovascular mortality alone were available in 310 patients at a mean follow-up of 4.01 ± 1.5 years.
  
  
  
  The majority of the patients had abnormal SPECT (n = 270, 71%). The abnormal SPECT patients compared to the normal were older (65.6 vs 62.8 years of age; P = .025), more likely to have abnormal left ventricular ejection fraction (26.1% vs 0%; P < .0001), known coronary artery disease (CAD, 35.9% vs 7.8%; P < .0001) and lower DTS (-14.5 vs -13.2; P = .0006), Kaplan-Meier survival analysis demonstrated a significantly lower cardiovascular mortality (5.4% vs 0%, P = .02) and combined outcome of MI and cardiovascular mortality (15% vs 4.4%, P = .009) in patients with normal versus abnormal SPECT.
  
  
  
  High-risk DTS is associated with abnormal perfusion SPECT in most patients, but nearly one-third of the patients had normal perfusion. Patients with a normal SPECT had a lower cardiovascular event rates.
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil. joaovitola@quantamn.com.br.
authors.forename: João V
authors.initials: JV
authors.lastname: Vítola
authors.affiliation: Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Mauro R B
authors.initials: MR
authors.lastname: Wanderley
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: Rodrigo J
authors.initials: RJ
authors.lastname: Cerci
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: Carlos C
authors.initials: CC
authors.lastname: Pereira Neto
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: Otávio
authors.initials: O
authors.lastname: Kormann
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: Olímpio França
authors.initials: OF
authors.lastname: Neto
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: José Antônio
authors.initials: JA
authors.lastname: da Silva
authors.affiliation: Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Cláudio L Pereira
authors.initials: CL
authors.lastname: da Cunha
authors.affiliation: Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Isabella
authors.initials: I
authors.lastname: Shin-Ike
authors.affiliation: Quanta - Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil.
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Stier
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Duke treadmill score; exercise testing; mortality; myocardial perfusion imaging; outcome; prognosis