Abstract
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Objectives: Left ventricular ejection fraction is useful for predicting the incidence of cardiac events. However, left ventricular ejection fraction may not be suitable for predicting the prognosis in asymptomatic patients who show mildly impaired left ventricular function and are suspected for coronary artery disease. We investigated the prognostic value of myocardial perfusion imaging in patients with mildly impaired left ventricular function who had no chest pain but were suspected for coronary artery disease.
Methods: Consecutive patients (n=72, mean age=67) who had no chest pain but had mildly impaired left ventricular function (mean left ventricular ejection fraction=52%) and were suspected for coronary artery disease were followed-up for 4.9 years after stress myocardial perfusion imaging. The follow-up time was censored at the occurrence of cardiac death, hospitalization for congestive heart failure, acute coronary syndrome, or revascularization. Images were scored using a 20-segment model and a 0-4 scale, and then the summed stress, rest, and difference scores (SSS, SRS, SDS) were calculated.
Results: During follow-up, cardiac death in 2 patients, hospitalization for congestive heart failure in 8 patients, acute coronary syndrome in 4 patients and revascularization in 2 patients occurred. Cox regression demonstrated that SDS>=4 was an excellent predictor of cardiac events in all patients (hazard ratio=4.2, p=0.01), and especially in diabetic patients (hazard ratio=28.4, p=0.01).
Conclusions: Stress myocardial perfusion imaging is useful for predicting cardiac events and may be performed even in patients with no chest pain if they have mildly impaired left ventricular function.
- Society of Nuclear Medicine, Inc.