From the Departments of Imaging (Division of Nuclear Medicine) and
Medicine (Division of Cardiology), Cedars-Sinai Medical Center, and the
Department of Medicine, UCLA School of Medicine, Los Angeles, Calif, and the
Division of Cardiology, Department of Medicine, Duke University Medical
Center, Durham, NC. Dr Hachamovitch is currently at the Division of
Cardiology, New York (NY) Hospital-Cornell Medical Center. Dr Shaw is
currently at the Department of Medicine (Division of Cardiology), Emory
University, Atlanta, Ga.
Correspondence to Daniel S. Berman, MD, Cedars-Sinai Medical Center, Room A042, 8700 Beverly Blvd, Los Angeles, CA 90048.
Background—The incremental
prognostic value of stress single photon emission computed tomography
(SPECT) for the prediction of cardiac death as an individual end point
and the implications for risk stratification are undefined.
Methods and Results—We identified 5183 consecutive patients
who underwent stress/rest SPECT and were followed up for the occurrence
of cardiac death or myocardial infarction. Over a mean follow up of
642±226 days, 119 cardiac deaths and 158 myocardial infarctions
occurred (3.0% cardiac death rate, 2.3% myocardial infarction rate).
Patients with normal scans were at low risk (
Conclusions—Myocardial perfusion SPECT yields incremental
prognostic information toward the identification of cardiac death.
Patients with mildly abnormal scans after exercise stress are at low
risk for cardiac death but intermediate risk for nonfatal myocardial
infarction and thus may benefit from a noninvasive strategy and may not
require invasive management.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
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
0.5%/y), and rates of
both outcomes increased significantly with worsening scan
abnormalities. Patients who underwent exercise stress and had mildly
abnormal scans had low rates of cardiac death but higher rates of
myocardial infarction (0.7%/y versus 2.6%/y; P<.05).
After adjustment for prescan information, scan results provided
incremental prognostic value toward the prediction of cardiac death.
The identification of patients at intermediate risk of nonfatal
myocardial infarction and low risk for cardiac death by SPECT may
result in significant cost savings when applied to a clinical testing
strategy.
Key Words: prognosis • tomography • perfusion
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B. F. Johnson, R. W. Nesto, M. A. Pfeifer, W. R. Slater, A. I. Vinik, D. A. Chyun, G. Law, F. J.Th. Wackers, and L. H. Young Cardiac Abnormalities in Diabetic Patients With Neuropathy: Effects of aldose reductase inhibitor administration Diabetes Care, February 1, 2004; 27(2): 448 - 454. [Abstract] [Full Text] [PDF]
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I. G. Poornima, T. D. Miller, T. F. Christian, D. O. Hodge, K. R. Bailey, and R. J. Gibbons Utility of myocardial perfusion imaging in patients with low-risk treadmill scores J. Am. Coll. Cardiol., January 21, 2004; 43(2): 194 - 199. [Abstract] [Full Text] [PDF]
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G. A. Beller and D. D. Watson Risk stratification using stress myocardial perfusion imaging: don't neglect the value of clinical variables J. Am. Coll. Cardiol., January 21, 2004; 43(2): 209 - 212. [Full Text] [PDF]
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G. S. Thomas, M. I. Miyamoto, A. P. Morello III, H. Majmundar, J. J. Thomas, C. H. Sampson, R. Hachamovitch, and L. J. Shaw Technetium99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting: The Nuclear Utility in the Community (NUC) Study J. Am. Coll. Cardiol., January 21, 2004; 43(2): 213 - 223. [Abstract] [Full Text] [PDF]
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A. Abidov, J. J. Bax, S. W. Hayes, R. Hachamovitch, I. Cohen, J. Gerlach, X. Kang, J. D. Friedman, G. Germano, and D. S. Berman 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., November 19, 2003; 42(10): 1818 - 1825. [Abstract] [Full Text] [PDF]
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N K Sabharwal and A Lahiri Role of myocardial perfusion imaging for risk stratification in suspected or known coronary artery disease Heart, November 1, 2003; 89(11): 1291 - 1297. [Abstract] [Full Text] [PDF]
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A. E. B. van der Burg, J. J. Bax, E. Boersma, E. K.J. Pauwels, E. E. van der Wall, and M. J. Schalij Impact of Viability, Ischemia, Scar Tissue, and Revascularization on Outcome After Aborted Sudden Death Circulation, October 21, 2003; 108(16): 1954 - 1959. [Abstract] [Full Text] [PDF]
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S. W. Hayes, A. De Lorenzo, R. Hachamovitch, S. C. Dhar, P. Hsu, I. Cohen, J. D. Friedman, X. Kang, and D. S. Berman Prognostic Implications of Combined Prone and Supine Acquisitions in Patients with Equivocal or Abnormal Supine Myocardial Perfusion SPECT J. Nucl. Med., October 1, 2003; 44(10): 1633 - 1640. [Abstract] [Full Text] [PDF]
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R. G. Schwartz, T. A. Pearson, V. G. Kalaria, M. L. Mackin, D. J. Williford, A. Awasthi, A. Shah, A. Rains, and J. J. Guido Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy: Coronary artery disease regression single photon emission computed tomography monitoring trial J. Am. Coll. Cardiol., August 20, 2003; 42(4): 600 - 610. [Abstract] [Full Text] [PDF]
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R. S. Blumenthal and T. J. Gluckman New insights into the relationship between myocardial perfusion and lipid-lowering J. Am. Coll. Cardiol., August 20, 2003; 42(4): 611 - 613. [Full Text] [PDF]
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M. J. Zellweger, M. Weinbacher, A. W. Zutter, R. V. Jeger, J. Mueller-Brand, C. Kaiser, P. T. Buser, and M. E. Pfisterer Long-term outcome of patients with silent versus symptomatic ischemia six months after percutaneous coronary intervention and stenting J. Am. Coll. Cardiol., July 2, 2003; 42(1): 33 - 40. [Abstract] [Full Text] [PDF]
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R. Hachamovitch, S. W. Hayes, J. D. Friedman, I. Cohen, and D. S. Berman Comparison of the Short-Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photon Emission Computed Tomography Circulation, June 17, 2003; 107(23): 2900 - 2907. [Abstract] [Full Text] [PDF]
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A. Abidov, R. Hachamovitch, S. W. Hayes, C. K. Ng, I. Cohen, J. D. Friedman, G. Germano, and D. S. Berman Prognostic Impact of Hemodynamic Response to Adenosine in Patients Older Than Age 55 Years Undergoing Vasodilator Stress Myocardial Perfusion Study Circulation, June 17, 2003; 107(23): 2894 - 2899. [Abstract] [Full Text] [PDF]
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T.H. Marwick, L. Shaw, C. Case, C. Vasey, and J.D. Thomas Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice Eur. Heart J., June 2, 2003; 24(12): 1153 - 1163. [Abstract] [Full Text] [PDF]
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R. Hachamovitch, S. Hayes, J. D. Friedman, I. Cohen, L. J. Shaw, G. Germano, and D. S. Berman Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: What is the warranty period of a normal scan? J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1329 - 1340. [Abstract] [Full Text] [PDF]
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D. S. Berman, X. Kang, S. W. Hayes, J. D. Friedman, I. Cohen, A. Abidov, L. J. Shaw, A. M. Amanullah, G. Germano, and R. Hachamovitch 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., April 2, 2003; 41(7): 1125 - 1133. [Abstract] [Full Text] [PDF]
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L. J. Shaw, R. Hendel, S. Borges-Neto, M. S. Lauer, N. Alazraki, J. Burnette, E. Krawczynska, M. Cerqueira, and J. Maddahi Prognostic Value of Normal Exercise and Adenosine 99mTc-Tetrofosmin SPECT Imaging: Results from the Multicenter Registry of 4,728 Patients J. Nucl. Med., February 1, 2003; 44(2): 134 - 139. [Abstract] [Full Text] [PDF]
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J. D. Anderson, L. Littmann, R. Hachamovitch, D. S. Berman, H. Kiat, I. Cohen, J. D. Friedman, and L. J. Shaw Stress Single Photon Emission Computed Tomography in Patients With Normal Electrocardiograms * Response Circulation, October 8, 2002; 106 (15): e71 - e72. [Full Text] [PDF]
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H. Okazawa, M. Takahashi, T. Hata, K. Sugimoto, Y. Kishibe, and T. Tsuji Quantitative Evaluation of Myocardial Blood Flow and Ejection Fraction with a Single Dose of 13NH3 and Gated PET J. Nucl. Med., August 1, 2002; 43(8): 999 - 1005. [Abstract] [Full Text] [PDF]
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 T. H. Marwick, C. Case, S. Sawada, C. Vasey, and J. D. Thomas Prediction of Outcomes in Hypertensive Patients With Suspected Coronary Disease Hypertension, June 1, 2002; 39(6): 1113 - 1118. [Abstract] [Full Text] [PDF]
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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]
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L. Emmett, R. M. Iwanochko, M. R. Freeman, A. Barolet, D. S. Lee, and M. Husain Reversible regional wall motion abnormalities on exercise technetium-99m-gated cardiac single photon emission computed tomography predict high-grade angiographic stenoses J. Am. Coll. Cardiol., March 20, 2002; 39(6): 991 - 998. [Abstract] [Full Text] [PDF]
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R. Wayhs, A. Zelinger, and P. Raggi High coronary artery calcium scores pose an extremely elevated risk for hard events J. Am. Coll. Cardiol., January 16, 2002; 39(2): 225 - 230. [Abstract] [Full Text] [PDF]
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F. J. Th. Wackers and B. L. Zaret Detection of Myocardial Ischemia in Patients With Diabetes Mellitus Circulation, January 1, 2002; 105(1): 5 - 7. [Full Text] [PDF]
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D.-S. Jeon, S. Atar, A. V. Brasch, H. Luo, J. Mirocha, T. Z. Naqvi, R. Kraus, D. S. Berman, and R. J. Siegel Association of mitral annulus calcification, aortic valve sclerosis and aortic root calcification with abnormal myocardial perfusion single photon emission tomography in subjects age <=65 years old J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1988 - 1993. [Abstract] [Full Text] [PDF]
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