Original ArticlesPrognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT
Abstract
Background. We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction. Methods and Results. We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P = .016) or by gated SPECT (OR 10.7, P = .009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P = .007) and greater than 15% ischemic extent in the polar map (OR 3.6, P = .04) of SPECT. Conclusions. Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications. (J Nucl Cardiol 2001;8:122-8.)
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2014, International Journal of CardiologyRecommendations on clinical indications for myocardial perfusion gated SPECT
2008, Revista Espanola de Medicina NuclearDesde 1999 no se había realizado ninguna revisión de las Guías de actuación clínica de la Sociedad Española de Cardiología en Cardiología Nuclear, por lo que en este artículo exponemos las indicaciones clase I y IIa de la American College of Cardiology/American Heart Association/American Society of Nuclear Cardiology (ACC/AHA/ASNC) con nivel de evidencia A o B, junto con las 27 indicaciones consideradas adecuadas por el Comité de expertos de la American College of Cardiology Foundation/American Society of Nuclear Cardiology (ACCF/ASNC) y los comentarios que hemos considerado oportuno añadir los firmantes de este artículo.
Guidelines on Nuclear Cardiology have not been revised since 1999. Correspondingly, this article describes the class-I and class-IIa indications of the American College of Cardiology (ACC)/American Heart Association (AHA)/American Society for Nuclear Cardiology (ASNC), which have a grade-A or grade-B level of supporting evidence. In addition, details are given of the 27 appropriateness criteria of the American College of Cardiology Foundation (ACCF)/ASNC expert committee, along with additional comments which the authors of this review thought were appropriate to make at this time.
Recommendations on clinical indications for myocardial perfusion gated SPECT
2008, Revista Espanola de Cardiologia SuplementosDesde 1999 no se había realizado ninguna revisión de las Guías de actuación clínica de la Sociedad Española de Cardiología en Cardiología Nuclear, por lo que en este artículo exponemos las indicaciones clase I y IIa de la American College of Cardiology/American Heart Association/American Society of Nuclear Cardiology (ACC/AHA/ASNC) con nivel de evidencia A o B, junto con las 27 indicaciones consideradas adecuadas por el Comité de expertos de la American College of Cardiology Foundation/American Society of Nuclear Cardiology (ACCF/ASNC) y los comentarios que hemos considerado oportuno añadir los firmantes de este artículo.
The Spanish Society of Cardiology's Clinical Practice Guidelines on Nuclear Cardiology have not been revised since 1999. Correspondingly, this article describes the class-I and class-IIa indications of the American College of Cardiology (ACC)/American Heart Association (AHA)/American Society for Nuclear Cardiology (ASNC), which have a grade-A or grade-B level of supporting evidence. In addition, details are given of the 27 appropriateness criteria of the American College of Cardiology Foundation (ACCF)/ASNC expert committee, along with additional comments which the authors of this review thought were appropriate to make at this time.
Prognostic value of myocardial perfusion gated SPECT in chronic coronary artery disease
2008, Revista Espanola de Cardiologia SuplementosHay una amplia evidencia científica de que las pruebas de cardiología nuclear permiten tomar decisiones médicas trascendentes, incluso en casos seleccionados sin información coronariográfica. Sin embargo, estas técnicas no son utilizadas por todos los clínicos. La información que aporta la gated-SPECT es realmente útil, en especial en pacientes de riesgo intermedio, y su rentabilidad clínica en la toma de decisiones terapéuticas ha sido ampliamente demostrada. En nuestro país, no obstante, todavía hay servicios de cardiología en los que no se incluye la gated-SPECT en el tratamiento sistemático de los pacientes con cardiopatía isquémica crónica. En esta revisión se comenta la literatura científica disponible relativa al pronóstico de la enfermedad coronaria crónica mediante gated-SPECT de perfusión miocárdica y se resumen, a modo de tabla, los datos objetivos, cualitativos y cuantitativos más importantes para la catalogación de los pacientes en riesgo bajo, intermedio o alto.
A wide range of scientific evidence supports the use of nuclear cardiology techniques in making vital therapeutic decisions, even, in certain situations, when coronary angiography findings are not available. However, not all clinicians make use of these techniques. The data provided by gated SPECT are particularly useful, especially in intermediaterisk patients, and their clinical value in therapeutic decisionmaking has been clearly demonstrated. In Spain, however, some cardiology departments still do not include gated SPECT in the routine assessment of patients with chronic coronary artery disease. This review discusses the current literature on the use of myocardial perfusion gated SPECT in determining prognosis in chronic coronary artery disease and summarizes, in tabular form, the most important objective qualitative and quantitative parameters used for classifying patients as high, intermediate or low risk.
Incremental prognostic value of combined perfusion and function assessment during myocardial gated SPECT in patients aged 75 years or older
2005, Journal of Nuclear CardiologyPerfusion and functional data obtained during gated single photon emission computed tomography (SPECT) have proven prognostic value in the middle-aged patient population. The aim of this study was to investigate whether perfusion and functional cardiac gated SPECT data have prognostic value in patients aged 75 years or older.
We studied clinical and gated SPECT predictors of cardiac and all-cause death in 294 patients aged 75 years or older with known or suspected coronary artery disease who were referred for tetrofosmin cardiac gated SPECT imaging. Summed perfusion scores were calculated in a 17-segment model by use of commercially available software (4D-MSPECT). Left ventricular functional data were calculated by use of QGS gated SPECT software. The median age of the study population was 78 years (range, 75-91 years). There were 160 men (54%) and 134 women (46%). During a median follow-up of 25.9 months (range, 1.8-36 months), 47 patients (16%) died (27 cardiac deaths). In a multivariate Cox proportional hazards regression analysis, the summed rest score (χ2 gain = 8.0, P = .009), transient ischemic dilatation index (χ2 gain = 6.3, P = .012), and resting left ventricular ejection fraction (χ2 gain = 7.0, P = .030) were independent predictors of all-cause death. The summed rest score (χ2 gain = 8.2, P = .004) and resting end-systolic volume (χ2 gain = 13.7, P = .005) were independent predictors of cardiac death.
This study showed that gated SPECT left ventricular functional data assessed during myocardial gated SPECT provide independent and incremental information above clinical and perfusion SPECT data for the prediction of cardiac and all-cause death in patients aged 75 years or older referred for myocardial SPECT imaging.
Myocardial perfusion (SPECT) in patients with non-Q-wave myocardial infarction
2005, Medicina ClinicaCon la denominación de infarto de miocardio sin onda Q se incluyen desde pequeños infartos sin apenas traducción gammagráfica, hasta infartos extensos con criterios gammagráficos de transmuralidad. El objetivo de este estudio ha sido valorar, mediante tomografía computarizada de fotón único (SPECT) de perfusión miocárdica, la intensidad y la localización de la necrosis miocárdica en los pacientes diagnosticados de infarto de miocardio sin onda Q.
Se ha estudiado a 206 pacientes con infarto de miocardio sin onda Q a quienes se realizó consecutivamente SPECT de perfusión miocárdica con 99mTc-tetrofosmina para valorar la intensidad y localización de los defectos de perfusión en esfuerzo y reposo.
La SPECT de reposo fue normal en 53 pacientes (26%) y en 41 (20%) se observó al menos un segmento con criterio gammagráfico de transmuralidad (ausencia de captación). La localización más frecuente de los defectos de perfusión fue en las regiones inferior y lateral. En la SPECT de esfuerzo-reposo se observó reversibilidad periinfarto en un 68,9% de los pacientes, mientras que un 30% presentaba isquemia a distancia.
La SPECT de perfusión miocárdica es una técnica de gran utilidad para valorar la localización, la extensión y la transmuralidad de los infartos de miocardio sin onda Q, así como la presencia de isquemia residual periinfarto y a distancia de la región de la necrosis.
The denomination non-Q-wave myocardial infarction ranges from small infarcts without scintigraphic abnormalities to severe and extensive necrosis with scintigraphic criteria of transmurality. The aim of the present study was to evaluate the severity and localization of necrosis in patients with non-Q-wave myocardial infarct, by myocardial perfusion single photon emission computed tomography (SPECT).
We evaluated 206 patients with non-Q-wave myocardial infarct consecutively studied by myocardial perfusion 99mTc-tetrofosmin SPECT. Severity and localization of perfusion defects at stress and rest were analyzed.
Rest SPECT was normal in 53 patients (26%) and in 41 patients (20%) at least one segment with scintigraphic criteria of transmurality (uptake absence) was observed. Perfusion defects were more frequently localized in inferior and lateral regions. Stress-rest reversibility in peri-infarct regions was observed in 68.9% of patients, and reversibility at a distance was observed in 30% of patients.
Myocardial perfusion SPECT is a useful technique for the evaluation of the localization, extension and transmurality of non-Q-wave myocardial infarction, and the residual periinfarction ischemia and ischemia at a distance of the necrosis.