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Research ArticleCLINICAL INVESTIGATIONS

Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease

René A. Tio, Ali Dabeshlim, Hans-Marc J. Siebelink, Johan de Sutter, Hans L. Hillege, Clark J. Zeebregts, Rudi A.J.O. Dierckx, Dirk J. van Veldhuisen, Felix Zijlstra and Riemer H.J.A. Slart
Journal of Nuclear Medicine February 2009, 50 (2) 214-219; DOI: https://doi.org/10.2967/jnumed.108.054395
René A. Tio
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Ali Dabeshlim
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Hans-Marc J. Siebelink
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Johan de Sutter
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Hans L. Hillege
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Clark J. Zeebregts
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Rudi A.J.O. Dierckx
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Dirk J. van Veldhuisen
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Felix Zijlstra
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Riemer H.J.A. Slart
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  • FIGURE 1. 
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    FIGURE 1. 

    Cardiac death-free survival curves for median values of MPR tertiles are shown. Median MPR values of each tertile (intertertile boundaries, 1.49 and 1.84) were taken to illustrate differences between these groups. Numbers indicate patients at risk and number of events per tertile (T).

  • FIGURE 2. 
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    FIGURE 2. 

    Hazard ratio curves and percentage distribution for MPR (A) and for LVEF (B).

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    TABLE 1

    Patient Characteristics for Each Tertile of MPR

    CharacteristicMPR, first tertile (<1.49) (n = 114)MPR, second tertile (1.49–1.84) (n = 116)MPR, third tertile (>1.84) (n = 114)Total (n = 344)P
    Age (y)69 ± 1168 ± 1062 ± 1166 ± 11<0.001
    Sex (F/M) (n)22/9226/9025/8973/2710.628
    Hypercholesterolemia (%)545364570.141
    Smoking (%)312838330.323
    Diabetes mellitus (%)121710130.539
    Hypertension (%)282929290.884
    Family history (%)324054420.001
    Previous myocardial infarction (%)82716171<0.001
    Previous CABG (%)293126290.661
    Previous PCI (n)444248450.506
    LVEF (%)30 ± 1437 ± 1341 ± 1736 ± 15<0.001
    Typical anginal complaints (%)778581810.747
    Left ventricular end-diastolic volume (mL)172 ± 91124 ± 62124 ± 81140 ± 82<0.001
    Aspirin (%)546868630.040
    Coumarin (%)442925330.003
    Statin (%)524861540.185
    Diuretic (%)47312434<0.001
    Digoxin (%)22118140.002
    β-blocker (%)647060650.489
    Angiotensin-converting enzyme-inhibitor/ARB (%)584042470.017
    Matching defect (% left ventricle)30 ± 1527 ± 1525 ± 1727 ± 160.012
    Location of matching defects: LAD/LCX/RCA area (%)29/33/4434/30/5532/18/5131/27/500.669/0.007/0.290
    Mismatching defect (% left ventricle)11 ± 108 ± 107 ± 99 ± 100.011
    Location of mismatching defects: LAD/LCX/RCA area (%)27/37/3326/24/2814/33/2222/31/280.017/0.393/0.055
    Normal area of left ventricle (%)59 ± 1965 ± 1968 ± 2164 ± 200.001
    Myocardial perfusion at rest (mL/min/100 g)96 ± 2385 ± 2280 ± 2187 ± 23<0.001
    Myocardial perfusion during stress (mL/min/100 g)117 ± 34139 ± 36177 ± 45145 ± 46<0.001
    • ARB = angiotensin type I receptor blocker; LAD = left anterior descending coronary artery; LCX = circumflex coronary artery; RCA = right coronary artery.

    • Categoric variables are show as percentage or as number; continuous variables as mean ± SD.

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    TABLE 2

    Univariate and Multivariate Cox Proportional Hazard Regression Analysis of Cardiac Death According to MPR

    Univariate analysisAge- and sex-adjusted analysis
    VariableHazard ratioPHazard ratioP
    MPR (per SD)4.18 (3.05–5.74)<0.0014.11 (2.98–5.67)<0.001
    Family history (yes)0.56 (0.32–0.98)0.0430.68 (0.38−1.21)0.191
    Previous myocardial infarction (yes)6.06 (2.20–16.71)0.0015.21 (1.87–14.54)0.002
    LVEF (per SD)2.79 (2.02–3.85)<0.0012.76 (2.00–3.82)<0.001
    LVEDV (per 10 mL)1.05 (1.03–1.08)<0.0011.06 (1.04–1.08)<0.001
    Aspirin (yes)0.41 (0.24–0.67)0.0010.40 (0.24–0.68)<0.001
    Diuretics (yes)5.58 (3.17–9.81)<0.0015.58 (3.15–9.91)<0.001
    Digoxin (yes)4.97 (2.94–8.39)<0.0014.94 (2.90–8.40)<0.001
    Matching (per 10%)1.40 (1.20–1.64)<0.0011.41 (1.20–1.66)<0.001
    Mismatching (per 10%)1.20 (0.95–1.51)0.1341.16 (0.91–1.50)0.226
    • CI = confidence interval; LVEDV = left ventricular end-diastolic volume.

    • Data in parentheses are 95% confidence intervals.

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Journal of Nuclear Medicine: 50 (2)
Journal of Nuclear Medicine
Vol. 50, Issue 2
February 2009
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Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease
René A. Tio, Ali Dabeshlim, Hans-Marc J. Siebelink, Johan de Sutter, Hans L. Hillege, Clark J. Zeebregts, Rudi A.J.O. Dierckx, Dirk J. van Veldhuisen, Felix Zijlstra, Riemer H.J.A. Slart
Journal of Nuclear Medicine Feb 2009, 50 (2) 214-219; DOI: 10.2967/jnumed.108.054395

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Comparison Between the Prognostic Value of Left Ventricular Function and Myocardial Perfusion Reserve in Patients with Ischemic Heart Disease
René A. Tio, Ali Dabeshlim, Hans-Marc J. Siebelink, Johan de Sutter, Hans L. Hillege, Clark J. Zeebregts, Rudi A.J.O. Dierckx, Dirk J. van Veldhuisen, Felix Zijlstra, Riemer H.J.A. Slart
Journal of Nuclear Medicine Feb 2009, 50 (2) 214-219; DOI: 10.2967/jnumed.108.054395
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