title: Uncontrolled risk factors and worsening perfusion pattern on SPECT myocardial perfusion imaging in medically treated patients with stable chronic ischaemic heart disease.
abstract: OBJECTIVE
  Few data exist on the correlation between the effectiveness of risk factor control and the evolution of myocardial perfusion over time in patients with stable ischaemic heart disease. The aim of the study was to evaluate the changes in stress-rest myocardial perfusion in medically treated patients with stable chronic ischaemic heart disease and the relationship with risk factor control.
  
  
  METHODS
  The study cohort included 174 consecutive patients (age 60 ± 9 years, 68 % men) undergoing stress-rest myocardial perfusion imaging (MPI) (study 1), who also underwent repeat evaluation (study 2) and who were clinically stable on medical therapy. Summed stress, rest and difference scores were calculated. According to the evolution of perfusion pattern from study 1 to study 2, patients were classified as improved, stable or worsened.
  
  
  RESULTS
  Study 2 was performed on average 2.7 years after study 1. Of the 174 patients, 47 (26.9 %), 53 (30.8 %) and 74 (42.5 %) were classified as stable, improved and worsened, respectively. A significant trend was observed between the number of risk factors at the time of study 1 and worsening of myocardial perfusion (24 % of patients with zero or one risk factor showed worsening, 31 % with two, and 59 % with three or more; p = 0.03). Moreover, patients with worsened perfusion had a higher number of poorly controlled risk factors.
  
  
  CONCLUSIONS
  Despite medical therapy and clinical stability, myocardial perfusion worsened in 42.5 % of patients. The risk profile was reclassified in half of the patients. Worsening occurred more frequently in patients with three or more risk factors at the time of study 1 and in those with poorly controlled risk factors at the time of study 2; in this subset of patients, even if clinically stable, reassessment after 2 years could be considered.
authors.affiliation: Department of Cardiology, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), via Revislate 13, Veruno, 28010, NO, Italy. claudio.marcassa@fsm.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcassa
authors.affiliation: Department of Nuclear Medicine, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), Veruno, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Campini
authors.affiliation: Department of Nuclear Medicine, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), Veruno, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calza
authors.affiliation: Department of Nuclear Medicine, S. Maugeri Fnd, IRCCS, Scientific Institute of Veruno (Italy), Veruno, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Zoccarato
mesh_terms: D000359:Aftercare; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D055414:Myocardial Perfusion Imaging; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Myocardial perfusion; Risk factor treatment; Risk stratification; SPECT; Secondary prevention