Prognostic value of high-speed stress myocardial perfusion imaging

Objectives We aimed to assess for the first time the prognostic value of a novel camera system (Spectrum-Dynamics) for high-speed SPECT myocardial perfusion imaging (HS-MPI), analyzed both visually and with fully automated quantification.

Methods 1625 consecutive patients who underwent exercise or adenosine HS-MPI were followed up (2.1 ± 0.6 years) for all-cause death (ACD). Visual % summed stress score (SSS) was calculated from 17-segment scoring (0 - 4 scale). Quantitative upright/supine software measured stress total perfusion deficit (TPD). Risk groups by %SSS were: 0 = normal (nl); 1 - 4 = probably nl (minimal perfusion defect); 5 - 10 = mildly abnormal (abnl); and >10 = moderately/ severely abnl, and by TPD were: 0 = nl; 1 - 2 = probably nl; 3-8 = mildly abnl; and >8 = moderately/severely abnl (previously established thresholds).

Results 58 ACD occurred (3.6% or 1.70% per year). Patients with SSS = 0 had 32 ACD and with TPD = 0 had 10 ACD. For both SSS and TPD, annualized ACD rates were low with nl MPI and increased progressively with increasing abnormality (log-rank test p = 0.0001, p = 0.0003) (Table).

Conclusions Prognostic findings of HS-MPI are comparable to of conventional MPI. Using visual or quantitative analysis, normal HS-MPI was associated with low ACD rates, and abnormal HS-MPI was associated increasing ACD rates with increasing of stress MPI abnormality. Increased ACD with minimal perfusion defect was distinguished from normal only by the quantitative method

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