| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Circulation, Vol 82, 1705-1717, Copyright © 1990 by American Heart Association
KL Lee, DB Pryor, KS Pieper, FE Harrell Jr, RM Califf, DB Mark, MA Hlatky, RE Coleman, FR Cobb and RH Jones
To evaluate the usefulness of multiple measures from rest and exercise
radionuclide angiography (RNA) in predicting cardiovascular death and
cardiovascular events (death or nonfatal myocardial infarction) and to
assess the prognostic usefulness of the RNA relative to clinical and
catheterization data, we studied 571 stable patients with symptomatic
coronary artery disease who had upright rest/exercise first-pass RNA within
3 months of catheterization and were medically treated. With a median
follow-up of 5.4 years, 90 patients have died from cardiovascular causes,
and 147 patients have either died or suffered a nonfatal myocardial
infarction. Using the Cox regression model and a preselected group of RNA
variables, the most important RNA predictor of mortality was exercise
ejection fraction (chi 2 = 81, p less than 0.00001). Neither rest ejection
fraction nor the change in ejection fraction from rest to exercise
contributed additional predictive information. Two other RNA study
variables, the change in heart rate from rest to exercise and rest
end-diastolic volume index, did contribute additional prognostic
information to the exercise ejection fraction (chi 2 = 23, p less than
0.0001). Compared with noninvasive clinical data (history, physical
examination, electrocardiogram, and chest radiograph), RNA variables were
considerably more predictive of mortality (chi 2 = 71 [clinical variables]
versus chi 2 = 104 [RNA]). Remarkably, the strength of the relation of RNA
variables with mortality was equivalent to that of the set of
catheterization variables previously demonstrated in our large angiographic
population to be prognostically important (chi 2 = 104 [RNA] versus chi 2 =
102 [catheterization variables]). The RNA contained 84% of the information
provided by clinical and catheterization descriptors combined. Furthermore,
the RNA contributed significant additional prognostic information to the
clinical and catheterization data (chi 2 = 13.6, p = 0.0035). For
cardiovascular events, the relative prognostic usefulness of the RNA was
similar, although relations with this outcome were generally weaker.
Descriptors from the rest/exercise RNA exhibit a powerful relation with
long-term outcomes and can be useful in defining risk, even when clinical
and catheterization data are available.
ARTICLES
Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables
Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710.
This article has been cited by other articles:
 |
|
 |
|
  R. H. Jones, E. J. Velazquez, R. E. Michler, G. Sopko, J. K. Oh, C. M. O'Connor, J. A. Hill, L. Menicanti, Z. Sadowski, P. Desvigne-Nickens, et al. Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction N. Engl. J. Med., April 23, 2009; 360(17): 1705 - 1717. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. H.J. Pijls, P. van Schaardenburgh, G. Manoharan, E. Boersma, J.-W. Bech, M. van't Veer, F. Bar, J. Hoorntje, J. Koolen, W. Wijns, et al. Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis: 5-Year Follow-Up of the DEFER Study J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2105 - 2111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Navare, D. Katten, L. L. Johnson, J. F. Mather, M. S. Fowler, A. W. Ahlberg, N. Miele, and G. V. Heller Risk Stratification With Electrocardiographic-Gated Dobutamine Stress Technetium-99m Sestamibi Single-Photon Emission Tomographic Imaging: Value of Heart Rate Response and Assessment of Left Ventricular Function J. Am. Coll. Cardiol., February 21, 2006; 47(4): 781 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Liao, W. T. Smith IV, R. H. Tuttle, L. K. Shaw, R. E. Coleman, and S. Borges-Neto Prediction of Death and Nonfatal Myocardial Infarction in High-Risk Patients: A Comparison Between the Duke Treadmill Score, Peak Exercise Radionuclide Angiography, and SPECT Perfusion Imaging J. Nucl. Med., January 1, 2005; 46(1): 5 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Meine, M. W. Hanson, and S. Borges-Neto The Additive Value of Combined Assessment of Myocardial Perfusion and Ventricular Function Studies J. Nucl. Med., October 1, 2004; 45(10): 1721 - 1724. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Fleming and L. D. Boyd High-Dose Dipyridamole and Gated Sestamibi SPECT Imaging Provide Diagnostic Resting and Stress Ejection Fractions Useful for Predicting Extent of Coronary Artery Disease Angiology, July 1, 2002; 53(4): 415 - 421. [Abstract] [PDF]
|
|
|
|
|
|
R. M. Fleming A Tete-a-Tete Comparison of Ejection Fraction and Regional Wall Motion Abnormalities as Measured by Echocardiography and Gated Sestamibi SPECT Angiology, May 1, 2002; 53(3): 313 - 321. [Abstract] [PDF]
|
|
|
|
|
|
R. B. McCully, V. L. Roger, D. W. Mahoney, K. N. Burger, R. L. Click, J. B. Seward, and P. A. Pellikka Outcome after abnormal exercise echocardiography for patients with good exercise capacity: Prognostic importance of the extent and severity of exercise-related left ventricular dysfunction J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1345 - 1352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Yamagishi, N. Shirai, M. Yoshiyama, M. Teragaki, K. Akioka, K. Takeuchi, J. Yoshikawa, and H. Ochi Incremental Value of Left Ventricular Ejection Fraction for Detection of Multivessel Coronary Artery Disease in Exercise 201Tl Gated Myocardial Perfusion Imaging J. Nucl. Med., February 1, 2002; 43(2): 131 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bigi, A. Desideri, R. Rambaldi, L. Cortigiani, C. Sponzilli, and C. Fiorentini Angiographic and Prognostic Correlates of Cardiac Output by Cardiopulmonary Exercise Testing in Patients With Anterior Myocardial Infarction Chest, September 1, 2001; 120(3): 825 - 833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Shaw, A. E. Iskandrian, R. Hachamovitch, G. Germano, H. C. Lewin, T. M. Bateman, and D. S. Berman Evidence-Based Risk Assessment in Noninvasive Imaging J. Nucl. Med., September 1, 2001; 42(9): 1424 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, J. Chen, Y.-T. Chen, Y. Wang, and M. J. Radford Predicting one-year mortality among elderly survivors of hospitalization for an acute myocardial infarction: results from the Cooperative Cardiovascular Project J. Am. Coll. Cardiol., August 1, 2001; 38(2): 453 - 459. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K. Teo and D. J. Catellier Risk prediction after myocardial infarction in the elderly J. Am. Coll. Cardiol., August 1, 2001; 38(2): 460 - 463. [Full Text] [PDF]
|
|
|
|
|
|
S. T. Mast, L. K. Shaw, G. C. Ravizzini, M. Chambless, P. Joski, R. E. Coleman, and S. Borges-Neto Incremental Prognostic Value of RNA Ejection Fraction Measurements During Pharmacologic Stress Testing: A Comparison with Clinical and Perfusion Variables J. Nucl. Med., June 1, 2001; 42(6): 871 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Brooks, R. H. Jones, R. G. Bach, B. R. Chaitman, M. J. Kern, T. A. Orszulak, D. Follmann, G. Sopko, E. H. Blackstone, and R. M. Califf Predictors of Mortality and Mortality From Cardiac Causes in the Bypass Angioplasty Revascularization Investigation (BARI) Randomized Trial and Registry Circulation, June 13, 2000; 101(23): 2682 - 2689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sharir, G. Germano, P. B. Kavanagh, S. Lai, I. Cohen, H. C. Lewin, J. D. Friedman, M. J. Zellweger, and D. S. Berman Incremental Prognostic Value of Post-Stress Left Ventricular Ejection Fraction and Volume by Gated Myocardial Perfusion Single Photon Emission Computed Tomography Circulation, September 7, 1999; 100(10): 1035 - 1042. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G P Armstrong, S G Carlier, K Fukamachi, J D Thomas, and T H Marwick Estimation of cardiac reserve by peak power: validation and initial application of a simplified index Heart, September 1, 1999; 82(3): 357 - 364. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Supino, J. S. Borer, E. M. Herrold, and C. Hochreiter Prognostication in 3-Vessel Coronary Artery Disease Based on Left Ventricular Ejection Fraction During Exercise : Influence of Coronary Artery Bypass Grafting Circulation, August 31, 1999; 100(9): 924 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hachamovitch, D. S. Berman, L. J. Shaw, H. Kiat, I. Cohen, J. A. Cabico, J. Friedman, and G. A. Diamond 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, February 17, 1998; 97(6): 535 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Panza, R. V. Curiel, J. M. Laurienzo, A. A. Quyyumi, and V. Dilsizian Relation Between Ischemic Threshold Measured During Dobutamine Stress Echocardiography and Known Indices of Poor Prognosis in Patients With Coronary Artery Disease Circulation, October 15, 1995; 92(8): 2095 - 2101. [Abstract] [Full Text]
|
|
|
|
|
|
K.M.A. Hussain, L. Gould, E.V. Pomerantsev, M. Angirekula, and T. Bharathan Comparative Study of Left Ventricular Function in Patients with Unstable Angina, Non-Q Wave Myocardial Infarction and Stable Angina Pectoris: Assessment with Atrial Pacing and Digital Ventriculography Angiology, October 1, 1995; 46(10): 867 - 876. [Abstract] [PDF]
|
|
|
|
|
|
B. L. Zaret and F. J. Wackers Nuclear Cardiology- Second of Two Parts N. Engl. J. Med., September 16, 1993; 329(12): 855 - 863. [Full Text]
|
|
|
|
 |
|
 M. M. Bodenheimer Risk Stratification in Coronary Disease: A Contrary Viewpoint Ann Intern Med, June 1, 1992; 116(11): 927 - 936. [Abstract] [PDF]
|
|