OtherClinical Investigations

Prognostic Implications of Combined Prone and Supine Acquisitions in Patients with Equivocal or Abnormal Supine Myocardial Perfusion SPECT

Sean W. Hayes, Andrea De Lorenzo, Rory Hachamovitch, Sanjay C. Dhar, Patrick Hsu, Ishac Cohen, John D. Friedman, Xingping Kang and Daniel S. Berman
Journal of Nuclear Medicine October 2003, 44 (10) 1633-1640;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Postexercise 99mTc-sestamibi MPS images of 83-y-old asymptomatic man. Perfusion defect is noted in inferior and inferoapical walls in poststress supine images. Poststress prone images are normal, demonstrating that apparent perfusion defect is secondary to soft-tissue attenuation. Normal wall motion was noted on gated SPECT.

  • FIGURE 2.
    FIGURE 2.

    Injection and acquisition protocol for prone and supine MPS study. *15 min for exercise, 1 h for no walk adenosine (adapted and reprinted with permission of (24)).

  • FIGURE 3.
    FIGURE 3.

    Risk-adjusted hard event rates in patients undergoing supine-only or prone and supine acquisition, according to MPS interpretation. P < 0.0001 across scan categories; P > 0.05 for comparisons between supine-only or prone and supine. Mod-sev = moderately to severely abnormal.

  • FIGURE 4.
    FIGURE 4.

    Risk-adjusted total event rates in patients undergoing supine-only or prone and supine acquisition, according to MPS interpretation. P < 0.0001 across scan categories; P > 0.05 for comparisons between supine-only or prone and supine. Mod-sev = moderately to severely abnormal.

Tables

  • TABLE 1

    Patient Characteristics

    CharacteristicProne and supine (n = 655)Supine-only (n = 3,179)
    Age (y)66.7 ± 11.165.7 ± 12.3
    Male sex487 (74.4)1,899 (59.7)*
    Hypertension319 (48.7)1,499 (47.2)
    Diabetes100 (15.3)467 (14.7)
    Hypercholesterolemia328 (50.1)1,466 (46.1)
    Smoking81 (12.4)381 (12.0)
    Family history of CAD169 (25.8)862 (27.1)
    History of MI155 (23.7)800 (25.2)
    History of revascularization216 (33.0)1,044 (32.8)
    Digitalis use44 (6.7)269 (8.5)
    Angina246 (37.6)1,216 (38.3)
    Shortness of breath35 (5.3)178 (5.6)
    Adenosine stress217 (33.1)1,071 (33.7)
    Prescan likelihood of CAD0.39 ± 0.360.36 ± 0.34*
    Abnormal rest ECG464 (70.8)2,308 (72.6)
    SSS6.3 ± 8.86.5 ± 9.3

    • ↵* P < 0.05.

    • MI = myocardial infarction.

    • Values in parentheses are percentage.

  • TABLE 2

    Patient Characteristics by MPS Acquisition Types and Normal or Abnormal MPS Results

    CharacteristicProne and supine (n = 655)Supine-only (n = 3,179)
    Normal (n = 368)Abnormal (n = 287)Normal (n = 1,880)Abnormal (n = 1,299)
    Age (y)64.4 ± 11.369.7 ± 10.163.0 ± 12.669.7 ± 10.6*
    Male sex260 (70.7)227 (79.1)*958 (51.0)†941 (72.4)*‡
    Hypertension172 (46.7)147 (51.2)799 (42.5)700 (53.9)
    Diabetes38 (10.3)62 (21.1)205 (10.9)262 (20.2)
    Hypercholesterolemia183 (49.7)145 (50.5)847 (45.1)619 (47.7)
    Smoking44 (12.0)37 (12.9)228 (12.1)153 (11.8)
    Family history of CAD92 (25.0)77 (26.8)495 (26.3)367 (28.3)
    History of MI23 (6.3)132 (46.0)144 (7.7)656 (50.5)
    History of revascularization56 (15.2)160 (55.7)165 (8.8)799 (61.5)*‡
    Digitalis use24 (6.5)20 (7.0)108 (5.7)161 (12.4)*‡
    Angina128 (34.8)118 (41.1)756 (40.2)460 (35.4)
    Shortness of breath16 (4.3)19 (6.6)82 (4.4)96 (7.4)
    Adenosine stress97 (26.4)120 (41.8)490 (26.1)581 (44.7)
    Prescan likelihood of CAD0.34 ± 0.300.44 ± 0.34*0.33 ± 0.290.45 ± 0.35*
    Abnormal rest ECG228 (62.0)236 (82.2)*1,164 (61.9)1,144 (88.1)*‡
    SSS0.5 ± 0.913.8 ± 8.7*0.5 ± 0.915.2 ± 9.1*‡

    • ↵* P < 0.05 normal vs. abnormal scan in acquisition category.

    • ↵† P < 0.05 normal prone and supine vs. normal supine-only.

    • ↵‡ P < 0.05 abnormal prone and supine vs. abnormal supine-only.

    • MI = myocardial infarction.

    • Values in parentheses are percentage.

  • TABLE 3

    Annualized Event Rates

    RateProne and supine (n = 655)Supine-only (n = 3,179)
    NormalMildly abnormalModerately to severely abnormalNormalMildly abnormalModerately to severely abnormal
    Total
     Hard events (%)0.70.52.9*0.51.64.8*
     Total events (%)2.87.99.3*1.87.711.9*
     n368971901,880382917
    Exercise
     Hard events (%)0.60.92.8*0.40.73.2*
     Total events (%)2.610.09.9*1.57.010.1*
     n271571101,390231487
    Adenosine
     Hard events (%)1.003.11.13.36.8*
     Total events (%)3.25.18.52.68.914.2*
     n974080490151430

    • ↵* P < 0.05 across scan categories.

  • TABLE 4

    Univariate Predictors of Hard Events

    PredictorWith hard events (n = 132)Without hard events (n = 3,702)
    Age (y)72.1 ± 11.565.7 ± 12.0*
    Male sex98 (74.2)2,288 (61.8)*
    Hypertension73 (55.3)1,745 (47.1)
    Diabetes31 (23.5)536 (14.5)*
    Hypercholesterolemia46 (34.8)1,748 (47.2)*
    Smoking18 (13.6)444 (12.0)
    Family history of CAD39 (29.5)992 (26.8)
    Digitalis use32 (24.2)281 (7.6)*
    History of MI71 (53.8)884 (23.9)*
    History of revascularization70 (53.0)1,190 (32.1)*
    Angina50 (37.9)1,412 (38.1)
    Shortness of breath19 (14.4)194 (5.2)*
    Adenosine stress78 (59.1)1,210 (32.7)*
    Prescan likelihood of CAD0.46 ± 0.340.37 ± 0.31
    Position
     Prone17 (12.9)638 (17.2)
     Supine115 (87.1)3,064 (82.8)
    Abnormal rest ECG16 (12.1)111 (3.0)*
    SSS16.5 ± 11.46.1 ± 8.9*

    • ↵* P < 0.05.

    • MI = myocardial infarction.

    • Values in parentheses are percentage.

  • TABLE 5

    Univariate Predictors of Total Events

    PredictorWith total events (n = 375)Without total events (n = 3,459)
    Age (y)69.5 ± 10.465.5 ± 12.2*
    Male sex277 (73.9)2,109 (61.0)*
    Hypertension197 (52.5)1,621 (46.9)*
    Diabetes85 (22.7)482 (13.9)*
    Hypercholesterolemia177 (47.2)1,617 (46.7)
    Smoking46 (12.3)416 (12.0)
    Family history of CAD106 (28.3)925 (26.7)
    Digitalis use52 (13.9)261 (7.5)*
    History of MI170 (45.3)785 (22.7)*
    History of revascularization222 (59.2)1,038 (30.0)*
    Angina142 (37.9)1,320 (38.2)
    Shortness of breath27 (7.2)186 (5.4)
    Adenosine stress170 (45.3)1,118 (32.3)*
    Prescan likelihood of CAD0.50 ± 0.340.37 ± 0.31*
    Position
     Prone67 (17.9)588 (17.0)
     Supine308 (82.1)2,871 (83.0)
    Abnormal rest ECG53 (14.1)263 (7.6)
    SSS13.2 ± 10.65.7 ± 8.7*

    • ↵* P < 0.05.

    • MI = myocardial infarction.

    • Values in parentheses are percentage.

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