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OtherClinical Investigations

Prognostic Significance of Dipyridamole-Induced ST Depression in Patients with Normal 82Rb PET Myocardial Perfusion Imaging

Benjamin J.W. Chow, James W. Wong, Keiichiro Yoshinaga, Terrence D. Ruddy, Kathryn Williams, Robert A. deKemp, Jean DaSilva and Rob S. Beanlands
Journal of Nuclear Medicine July 2005, 46 (7) 1095-1101;
Benjamin J.W. Chow
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James W. Wong
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Keiichiro Yoshinaga
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Terrence D. Ruddy
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Kathryn Williams
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Robert A. deKemp
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Jean DaSilva
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Rob S. Beanlands
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  • Article
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Article Figures & Data

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  • FIGURE 1.
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    FIGURE 1.

    Kaplan–Meier survival curve for cardiac death, nonfatal MI, and revascularization.

Tables

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    TABLE 1

    Patient Demographics

    CharacteristicIschemic ECG (n = 72)Nonischemic ECG (n = 557)P value
    Age (y)61 ± 1159 ± 11NS
    Female60 (83)391 (70)<0.03
    BMI (kg/m2)27 ± 529 ± 7NS
    Cardiac risk factors
        Smoker7 (10)89 (16)NS
        Hypertension44 (61)276 (50)NS
        Diabetes14 (20)71 (13)NS
        Dyslipidemia42 (58)307 (55)NS
        Family history of CAD35 (49)265 (48)NS
    Cardiac medications
        Aspirin37 (52)247 (44)NS
        β-Blocker25 (35)179 (32)NS
        HMG-CoA reductase34 (49)212 (38)NS
        ACE-I21 (30)132 (24)NS
    Past medical history
        MI7 (10)52 (9)NS
        PCI6 (8)70 (13)NS
        CABG2 (3)18 (3)NS
        Coronary angiography25 (35)134 (24)NS
    • NS = not significant; BMI = body mass index; HMG-CoA reductase = statin; ACE-I = angiotensin-converting enzyme inhibitor.

      Values in parentheses are percentages.

    • View popup
    TABLE 2

    Rest and Dipyridamole Stress 82Rb PET in Patients With and Without Ischemic ECG Changes

    ParameterIschemic ECG (n = 72)Nonischemic ECG (n = 557)P value
    Resting heart rate (bpm)73 ± 1366 ± 11<0.001
    Resting blood pressure (mm Hg)
        Systolic147 ± 20140 ± 220.01
        Diastolic79 ± 1176 ± 130.01
    Peak stress heart rate (bpm)99 ± 1685 ± 14<0.001
    Peak stress blood pressure (mm Hg)
        Systolic150 ± 24138 ± 22<0.001
        Diastolic78 ± 2073 ± 14NS
    Rate · pressure product
        Rest10,717 ± 2,5459,278 ± 2,246<0.001
        Stress14,916 ± 3,56411,722 ± 2,774<0.001
    Persantine-induced chest pain*39 (54)230 (41)<0.05
    Stress ECG
        ST depression*72 (100)0<0.001
            Leads with ST depression3.6 ± 1.90<0.001
            Maximum ST depression (mm)1.3 ± 0.40<0.001
    MPI
        SSS0.15 ± 0.530.19 ± 0.49NS
        SRS0.32 ± 0.730.7 ± 1.58<0.03
        SDS0.10 ± 0.310.07 ± 0.23NS
    • ↵* Values in parentheses are percentages.

    • bpm = beats per minute; NS = not significant.

    • View popup
    TABLE 3

    Cardiac Events

    ParameterIschemic ECG (n = 72)Nonischemic ECG (n = 557)P value
    Mean follow-up (mo)26.3 ± 11.027.2 ± 13.3NS
    Cardiac death00NS
    Nonfatal MI1 (1.4)0NS
    Revascularization2 (2.8)11 (2.0)NS
        PCI1 (1.4)8 (1.4)NS
        CABG1 (1.4)3 (0.5)NS
    Coronary angiography3 (4.2)22 (4.0)NS
    Cardiac death and nonfatal MI1 (1.4)0NS
    Cardiac death, nonfatal MI, or revascularization3 (4.2)11 (2.0)NS
    • NS = not significant.

      Values in parentheses are percentages.

    • View popup
    TABLE 4

    Baseline Characteristics of Patients with Vasodilator-Induced ST Depression

    Vasodilator-induced ST depressionChow et al. (this study) PET (n = 72)Klodas et al. (9) SPECT (n = 49)Abbott et al. (10) SPECT (n = 66)
    Age (y)61 ± 11.067 ± 1064.8 ± 15.3
    Female (%)838882
    β-Blocker (%)3524
    CAD (%)3030
    MI (%)102.0
    Revascularization (%)9.710.2
    Dyslipidemia (%)585542
    Hypertension (%)615777
    Diabetes (%)201432
    Smoker (%)103329
    • View popup
    TABLE 5

    Cardiac Events in Patients with Vasodilator-Induced ST Depression and Normal MPI

    Annual event rateChow et al. (this study) PETKlodas et al. (9) SPECTAbbott et al. (10) SPECT
    Cardiac death and nonfatal MI (%)0.654.0
    Cardiac death, nonfatal MI, and revascularization (%)1.997.0
    • View popup
    TABLE 6

    Patient Demographics: Patients Lost to Follow-Up or Refused to Participate in Study

    CharacteristicPatients with follow-up (n = 629)Patients without follow-up (n = 65)P value
    Age (y)59 ± 1156 ± 12<0.03
    Female451 (72)38 (58)<0.05
    BMI (kg/m2)29 ± 729 ± 7NS
    Cardiac risk factors
        Smoker96 (15)8 (12)NS
        Hypertension320 (51)27 (42)NS
        Diabetes85 (14)12 (18)NS
        Dyslipidemia349 (56)25 (38)<0.03
        Family history of CAD300 (48)27 (42)NS
    Cardiac medications
        Aspirin284 (45)27 (42)NS
        β-Blocker204 (33)20 (31)NS
        HMG-CoA reductase247 (39)18 (28)NS
        ACE-I153 (24)9 (14)NS
    Past medical history
        MI59 (9)8 (12)NS
        PCI76 (12)5 (8)NS
        CABG20 (3)1 (2)NS
        Coronary angiography159 (25)16 (25)NS
    • BMI = body mass index; NS = not significant; HMG-CoA reductase = statin; ACE-I = angiotensin-converting enzyme inhibitor.

      Values in parentheses are percentages.

    • View popup
    TABLE 7

    Rest and Dipyridamole Stress 82Rb PET in Patients With and Without Follow-Up

    ParameterPatients with follow-up (n = 629)Patients without follow-up (n = 65)P value
    Resting heart rate (bpm)67 ± 1268 ± 12NS
    Resting blood pressure (mm Hg)
        Systolic141 ± 22144 ± 24NS
        Diastolic76 ± 1378 ± 12NS
    Peak stress heart rate (bpm)86 ± 1585 ± 15NS
    Peak stress blood pressure (mm Hg)
        Systolic140 ± 23141 ± 24NS
        Diastolic73 ± 1574 ± 12NS
    Rate · pressure product
        Rest9,443 ± 2,3259,749 ± 2,219NS
        Stress12,087 ± 3,04711,926 ± 2,688NS
    Dipyridamole-induced chest pain*269 (43)23 (35)NS
    MPI
        SSS0.19 ± 0.490.22 ± 0.46NS
        SRS0.65 ± 1.500.72 ± 1.20NS
        SDS0.08 ± 0.240.05 ± 0.19NS
    • ↵* Values in parentheses are percentages.

    • bpm = beats per minute; NS = not significant.

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Journal of Nuclear Medicine: 46 (7)
Journal of Nuclear Medicine
Vol. 46, Issue 7
July 1, 2005
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Prognostic Significance of Dipyridamole-Induced ST Depression in Patients with Normal 82Rb PET Myocardial Perfusion Imaging
Benjamin J.W. Chow, James W. Wong, Keiichiro Yoshinaga, Terrence D. Ruddy, Kathryn Williams, Robert A. deKemp, Jean DaSilva, Rob S. Beanlands
Journal of Nuclear Medicine Jul 2005, 46 (7) 1095-1101;

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Prognostic Significance of Dipyridamole-Induced ST Depression in Patients with Normal 82Rb PET Myocardial Perfusion Imaging
Benjamin J.W. Chow, James W. Wong, Keiichiro Yoshinaga, Terrence D. Ruddy, Kathryn Williams, Robert A. deKemp, Jean DaSilva, Rob S. Beanlands
Journal of Nuclear Medicine Jul 2005, 46 (7) 1095-1101;
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