The prognostic value of stress/rest gated myocardial perfusion SPECT in patients with known or suspected coronary artery disease

Document Type: Original Article

Authors

1 Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Nuclear Medicine Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction:Gated myocardial perfusion SPECT has diagnostic and prognostic values in coronary artery disease (CAD). We tried to determine prognostic values of the left ventricular perfusion & functional indices as well as transient left ventricular dilation (TID) derived from gated myocardial perfusion SPECT.
Methods: 1820patients who underwent gated myocardial perfusion SPECT (Gated SPECT) were studied. The summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS) were calculated. Cardiac events considered as nonfatal myocardial infarction, cardiac death, Coronary Care Unit admission and revascularization. Mean follow-up period after Gated SPECT was 23±10 months.
Results: 1599 patients didn't have any events, while from remaining 221, six patients had an acute MI, 90 patients had CCU admission, 42 patients underwent revascularization and 84 patients died. There was statistically significant difference in the cardiac events based on age, sex, SSS, SRS, SDS, TPD, TID, left ventricular volumes and LVEF. Multivariable Cox regression analysis showed the most and independent predictors of cardiac events are age (P=0.001), SSS (P=0.01) and history of coronary angiography (CA) (P=0.01). History of CA had a greater than 4.4 fold increased incidence of a cardiac event. With increase in SSS for 1 score, 1.4 times and with increase one year in age 1.4 fold increase in future cardiac event were seen.

Conclusion: There was a strong association between future cardiac events and clinical history, SSS, SRS, SDS, TPD, TID, left ventricular volumes and LVEF. The most and independent predictors were age, SSS and history of CA.

Keywords

Main Subjects


  1. Galassi AR, Azzarelli S, Tomaselli A, Giosofatto R, Ragusa A, Musumeci S, Tamburino C, Giuffrida G. Incremental prognostic value of technetium-99m-tetrofosmin exercise myocardial perfusion imaging for predicting outcomes in patients with suspected or known coronary artery disease. Am J Cardiol. 2001 Jul 15;88(2):101-6.
  2. Stratmann HG, Williams GA, Wittry MD, Chaitman BR, Miller DD. Exercise technetium-99m sestamibi tomography for cardiac risk stratification of patients with stable chest pain. Circulation. 1994 Feb;89(2):615-22.
  3. Iskander S, Iskandrian AE. Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol. 1998 Jul;32(1):57-62.
  4. Miernik S, Kaźmierczak-Dziuk A, Kamiński G, Dziuk M. The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results. Nucl Med Rev Cent East Eur. 2012 Apr 24;15(1):31-8.
  5. Kostkiewicz M, Szot W. The prognostic value of normal myocardial perfusion SPECT with positive coronary angiography. Nucl Med Rev Cent East Eur. 2012 Apr 24;15(1):22-5.
  6. Vinjamuri S, Jayan R. Role of myocardial perfusion imaging in risk stratification. Nucl Med Rev Cent East Eur. 2003;6(2):147-9.
  7. Soman P, Parsons A, Lahiri N, Lahiri A. The prognostic value of a normal Tc-99m sestamibi SPECT study in suspected coronary artery disease. J Nucl Cardiol. 1999 May-Jun;6(3):252-6.
  8. Travin MI, Heller GV, Johnson LL, Katten D, Ahlberg AW, Isasi CR, Kaplan RC, Taub CC, Demus D. The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging. J Nucl Cardiol. 2004 May-Jun;11(3):253-62.
  9. Brown KA. Prognostic value of thallium-201 myocardial perfusion imaging. A diagnostic tool comes of age. Circulation. 1991 Feb;83(2):363-81.
  10. Hendel RC, Chaudhry FA, Bonow RO. Myocardial viability. Curr Probl Cardiol. 1996 Mar;21(3):145-221.
  11. Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I, Gerlach J, Kang X, Friedman JD, Germano G, Berman DS. Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol. 2003 Nov 19;42(10):1818-25.
  12. Kakhki VR, Zakavi SR, Sadeghi R. Comparison of two software in gated myocardial perfusion single photon emission tomography, for the measurement of left ventricular volumes and ejection fraction, in patients with and without perfusion defects. Hell J Nucl Med. 2007 Jan-Apr;10(1):19-23.
  13. Dabbagh Kakhki VR. Myocardial perfusion SPECT: Perfusion quantification. Iran J Nucl Med. 2015;23(1):49-52.
  14. Dabbagh Kakhki VR, Jabari H. Dipyridamole stress and rest gated 99mTc-sestamibi myocardial perfusion SPECT: left ventricular function indices and myocardial perfusion findings. Iran J Nucl Med. 2007;15(1):1-7.
  15. Siennicki J, Kuśmierek J, Kovacevic-Kuśmierek K, Bieńkiewicz M, Chiżyński K, Płachcińska A. The effect of image translation table on diagnostic efficacy of myocardial perfusion SPECT studies. Nucl Med Rev Cent East Eur. 2010;13(2):64-9.
  16. Schinkel AF, Elhendy A, van Domburg RT, Bax JJ, Vourvouri EC, Bountioukos M, Rizzello V, Agricola E, Valkema R, Roelandt JR, Poldermans D. Incremental value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of cardiac events. Am J Cardiol. 2003 Feb 15;91(4):408-11.
  17. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998 Feb 17;97(6):535-43.
  18. Raza H, Mushtaq S, Kamal S. Prognostic value of normal exercise Tc-99m Sestamibi myocardial perfusion imaging in Karachi, Pakistan. J Pak Med Assoc. 2012 Apr;62(4):351-4.
  19. Brown KA, Altland E, Rowen M. Prognostic value of normal technetium-99m-sestamibi cardiac imaging. J Nucl Med. 1994 Apr;35(4):554-7.
  20. Groutars RG, Verzijlbergen JF, Muller AJ, Ascoop CA, Tiel-van Buul MM, Zwinderman AH, van Hemel NM, van der Wall EE. Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT. J Nucl Cardiol. 2000 Jul-Aug;7(4):333-41.
  21. Zorga P, Birkenfeld B, Listewnik MH, Piwowarska-Bilska H. Prognostic value of myocardial perfusion scintigraphy for patients suspected of and diagnosed with coronary artery disease. Nucl Med Rev Cent East Eur. 2012 Apr 24;15(1):14-21.
  22. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, Friedman JD, Germano G, Van Train K, Diamond GA. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995 Sep;26(3):639-47.
  23. Shaw LJ, Hendel RC, Heller GV, Borges-Neto S, Cerqueira M, Berman DS. Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT. J Nucl Cardiol. 2008 Nov-Dec;15(6):762-73.
  24. Berman DS, Shaw LJ, Hachamovitch R, Friedman JD, Polk DM, Hayes SW, Thomson LE, Germano G, Wong ND, Kang X, Rozanski A. Comparative use of radionuclide stress testing, coronary artery calcium scanning, and noninvasive coronary angiography for diagnostic and prognostic cardiac assessment.  Semin Nucl Med. 2007 Jan;37(1):2-16.
  25. Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S.  Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging. 2008 Feb;35(2):319-28. 
  26. Berman DS, Kang X, Hayes SW, Friedman JD, Cohen I, Abidov A, Shaw LJ, Amanullah AM, Germano G, Hachamovitch R. Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. J Am Coll Cardiol. 2003 Apr 2;41(7):1125-33.
  27. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998 Jul 23;339(4):229-34.
  28. Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, Friedman JD, Zellweger MJ, Berman DS. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation. 1999 Sep 7;100(10):1035-42.
  29. Kakhki VR, Sadeghi R, Zakavi SR. Assessment of transient left ventricular dilation ratio via 2-day dipyridamole Tc-99m sestamibi nongated myocardial perfusion imaging. J Nucl Cardiol. 2007 Jul;14(4):529-36.