title: Prognostic value of normal stress-only myocardial perfusion imaging: a comparison between conventional and CZT-based SPECT.
abstract: OBJECTIVE
  Single photon emission computed tomography (SPECT) myocardial perfusion imaging has proven to have prognostic importance in patients with suspected stable coronary artery disease (CAD). The recently introduced ultrafast cadmium zinc telluride (CZT)-based gamma cameras have been associated with less equivocal findings and more normal interpretations, allowing stress-only imaging to be performed more often. However, it is yet unclear whether normal stress-only CZT SPECT has comparable prognostic value as normally interpreted stress-only conventional SPECT.
  
  
  METHODS
  The study population consisted of 1,650 consecutive patients without known CAD with normal stress-only myocardial perfusion results with either conventional (n = 362) or CZT SPECT (n = 1,288). The incidence of major adverse cardiac events (MACE, all-cause death, non-fatal myocardial infarction and/or coronary revascularization) was compared between the conventional SPECT and CZT SPECT groups. Multivariable analyses using the Cox model were used to adjust for differences in baseline variables.
  
  
  RESULTS
  Patients scanned with CZT were less often male (33 vs 39 %), had less often hypercholesterolaemia (41 vs 50 %) and had more often a family history of CAD (57 vs 49 %). At a median follow-up time of 37 months (interquartile range 28-45 months) MACE occurred in 68 patients. The incidence of MACE was 1.5 %/year in the CZT group, compared to 2.0 %/year in the conventional group (p = 0.08). After multivariate analyses, there was a trend to a lower incidence of MACE in the CZT SPECT group (hazard ratio 0.61, 95 % confidence interval 0.35-1.04, p = 0.07).
  
  
  CONCLUSIONS
  The prognostic value of normal stress-only CZT SPECT is at least comparable and may be even better than that of normal conventional stress SPECT.
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB JW, Zwolle, The Netherlands.
authors.forename: Shu
authors.initials: S
authors.lastname: Yokota
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB JW, Zwolle, The Netherlands. m.mouden@isala.nl.|Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands. m.mouden@isala.nl.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouden
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB JW, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB JW, Zwolle, The Netherlands.|Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Elsemiek
authors.initials: E
authors.lastname: Engbers
authors.affiliation: Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Siert
authors.initials: S
authors.lastname: Knollema
authors.affiliation: Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB JW, Zwolle, The Netherlands.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands.
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
mesh_terms: D000368:Aged; D002104:Cadmium; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D019275:Radiopharmaceuticals; D013691:Tellurium; D015899:Tomography, Emission-Computed, Single-Photon; D015032:Zinc
chemical_list: C474490:CdZnTe; D019275:Radiopharmaceuticals; D002104:Cadmium; D015032:Zinc; D013691:Tellurium
keywords: Cadmium zinc telluride; Myocardial perfusion imaging; Prognosis; Single photon emission computed tomography; Stable coronary artery disease; Stress-only imaging