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First published online March 16, 2009, 10.2967/jnumed.108.055954
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Journal of Nuclear Medicine Vol. 50 No. 4 546-553
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.108.055954

Clinical Investigation

Stress/Rest Myocardial Perfusion Abnormalities by Gated SPECT: Still the Best Predictor of Cardiac Events in Stable Ischemic Heart Disease

Alessia Gimelli1, Giuseppe Rossi2, Patrizia Landi1, Paolo Marzullo1, Giorgio Iervasi1, Antonio L'Abbate1,3 and Daniele Rovai1

1 CNR Clinical Physiology Institute, G. Monasterio Foundation, Pisa, Italy; 2 Unit of Biostatistics and Epidemiology, CNR Clinical Physiology Institute, G. Monasterio Foundation, Massa, Italy; and 3 Scuola Superiore Sant'Anna, Pisa, Italy

Correspondence: For correspondence or reprints contact: Alessia Gimelli, CNR Clinical Physiology Institute, San Cataldo Research Area, Via Moruzzi, 1 56124 Pisa, Italy. E-mail: gimelli{at}ifc.cnr.it

The prognostic power of myocardial perfusion imaging in patients with ischemic heart disease (IHD) has been demonstrated since planar imaging. We aimed to investigate whether gated SPECT retains this value in current cardiology if compared with a complete diagnostic work-up and with more recent prognostic indicators. Methods: We selected from our database a cohort of 676 consecutive inpatients who underwent a complete diagnostic work-up that included gated SPECT and coronary arteriography for known or suspected IHD. Patients with acute myocardial infarction (MI), previous coronary artery bypass surgery, or overt hyperthyroidism and patients who were undergoing dialysis treatment were excluded. During follow-up (median, 37 mo), 24 patients died from cardiac causes and 19 experienced a nonfatal MI. Results: The following were determined to be independent predictors of event-free survival (cardiac death and nonfatal MI) in the different phases of diagnostic work-up using Cox proportional hazards regression analysis: among clinical variables, a previous MI; among laboratory examinations, serum creatinine and low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels; among electrocardiographic and echocardiographic variables, left ventricular ejection fraction; and among SPECT variables, summed rest score (SRS) and summed difference score (SDS). In addition, a score of coronary stenoses at angiography was an independent predictor. When the above predictors were tested together, SRS (P < 0.0001), SDS (P = 0.0108), and serum creatinine (P = 0.0186) and LDL and HDL cholesterol levels (P = 0.0222) were the final independent predictors of event-free survival. When gated SPECT was added to the clinical, laboratory, electrocardiographic, and echocardiographic variables, the prognostic stratification significantly improved (P < 0.05); when coronary arteriography was added to gated SPECT, prognostic stratification did not further improve (P > 0.25). If the information provided by gated SPECT was made available after clinical, laboratory, electrocardiographic, echocardiographic, and angiographic variables, the prognostic stratification still improved significantly (P < 0.05). In 492 of these patients with ascertained IHD, SRS and SDS were the final independent predictors of survival. Medical treatment and coronary revascularization did not affect the prognostic information of gated SPECT. Conclusion: Myocardial perfusion abnormalities at rest and after stress are still the best predictors of cardiac event–free survival in patients with known or suspected IHD, even when compared with an extensive diagnostic work-up.

Key Words: gated SPECT • ischemic heart disease • prognosis • myocardial perfusion imaging • laboratory tests

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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