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Kusumoto D, Akiyama T, Hashimoto M, Iwabuchi Y, Katsuki T, Kimura M, Akiba Y, Sawada H, Inohara T, Yuasa S, Fukuda K, Jinzaki M, Ieda M. A deep learning-based automated diagnosis system for SPECT myocardial perfusion imaging. Sci Rep 2024; 14:13583. [PMID: 38866884 PMCID: PMC11169468 DOI: 10.1038/s41598-024-64445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/10/2024] [Indexed: 06/14/2024] Open
Abstract
Images obtained from single-photon emission computed tomography for myocardial perfusion imaging (MPI SPECT) contain noises and artifacts, making cardiovascular disease diagnosis difficult. We developed a deep learning-based diagnosis support system using MPI SPECT images. Single-center datasets of MPI SPECT images (n = 5443) were obtained and labeled as healthy or coronary artery disease based on diagnosis reports. Three axes of four-dimensional datasets, resting, and stress conditions of three-dimensional reconstruction data, were reconstructed, and an AI model was trained to classify them. The trained convolutional neural network showed high performance [area under the curve (AUC) of the ROC curve: approximately 0.91; area under the recall precision curve: 0.87]. Additionally, using unsupervised learning and the Grad-CAM method, diseased lesions were successfully visualized. The AI-based automated diagnosis system had the highest performance (88%), followed by cardiologists with AI-guided diagnosis (80%) and cardiologists alone (65%). Furthermore, diagnosis time was shorter for AI-guided diagnosis (12 min) than for cardiologists alone (31 min). Our high-quality deep learning-based diagnosis support system may benefit cardiologists by improving diagnostic accuracy and reducing working hours.
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Affiliation(s)
- Dai Kusumoto
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
- Center for Preventive Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Takumi Akiyama
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yu Iwabuchi
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Toshiomi Katsuki
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Mai Kimura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yohei Akiba
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hiromune Sawada
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaki Ieda
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Hulten EA. A cardiovascular risk model validated in Japan applied to an Italian cohort: Procedere con prudenza. J Nucl Cardiol 2023; 30:1454-1457. [PMID: 36949179 DOI: 10.1007/s12350-023-03242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Edward A Hulten
- Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
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Prognostic risk stratification based on left ventricular mechanical dyssynchrony in patients at low or intermediate risk of major cardiac events using the J-ACCESS risk model. Heart Vessels 2023; 38:195-206. [PMID: 35960340 DOI: 10.1007/s00380-022-02155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/27/2022] [Indexed: 01/10/2023]
Abstract
There have been no reports on prognostic prediction and risk stratification based on stress phase bandwidth (SPBW), or a left ventricular (LV) mechanical dyssynchrony index, in patients with known or suspected stable coronary artery disease (CAD) at low or intermediate risk of major cardiac events (MCEs) using the J-ACCESS risk model. We retrospectively investigated 4,996 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and followed up for 3 years to confirm their prognosis. MCE risk over 3 years was estimated using an equation based on that used in the J-ACCESS study. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), and severe heart failure requiring hospitalization. SPBW was calculated by phase analysis with the Heart Risk View-F software and its normal upper limit was set to 38°. Based on the estimated 3-year incidence of MCEs obtained from the J-ACCESS risk model, 4,123 of the 4,996 consecutive patients were classified as low (n = 2,653) or intermediate risk (n = 1,470) and they were analyzed for follow-up. During the follow-up, 153 patients experienced MCEs: cardiac death (n = 38), non-fatal MI (n = 45), and severe heart failure (n = 70). The results of the multivariate analysis showed age, estimated glomerular filtration rate (eGFR), stress LV ejection fraction, and stress SPBW to be independent predictors of MCEs. The actual 3-year MCE rate in patients at intermediate risk was significantly higher than in those at low risk (6.7% vs. 2.1%, P < 0.0001). However, the actual 3-year MCE rate in patients with abnormal SPBW (> 38°) was 4.0% and 9.2% in low- and intermediate-risk patients, respectively, which corresponded to intermediate and high risk. Kaplan-Meier analysis also showed significant risk stratification by normal SPBW values for both low- and intermediate-risk patients. LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for risk stratification of known or suspected stable CAD patients at low or intermediate risk of MCEs and may help identify higher risk patients who could not be identified as being at risk based on J-ACCESS risk assessment.
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Sakatani T, Nakajima K, Nishimura T. Cardiovascular event risk estimated by myocardial perfusion SPECT combined with clinical data. J Cardiol 2021; 80:64-71. [PMID: 34728122 DOI: 10.1016/j.jjcc.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
Myocardial scintigraphy plays important roles in the diagnosis of coronary artery disease, prognostic risk stratification, and determination of the treatment policy. Recently, several large-scale clinical trials reported that coronary intervention was not necessarily advantageous for preventing future cardiac events in patients with stable angina. This review summarizes how we can estimate cardiac event risks based on Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS), and describes that the combination of scintigraphy and other clinical features leads to more accurate stratification of prognosis and the determination of subsequent treatment policy.
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Affiliation(s)
- Tomohiko Sakatani
- Department of Cardiology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan.
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Patriki D, Giannopoulos AA. Cardiovascular risk prediction models with myocardial perfusion imaging in chronic kidney disease: ACCESSing digits or focusing on the patient? J Nucl Cardiol 2020; 27:51-52. [PMID: 30014349 DOI: 10.1007/s12350-018-1367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Dimitri Patriki
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Misaka T, Sugitani Y, Asato N, Matsukubo Y, Uemura M, Ashikaga R, Ishida T. Coronary artery to aortic luminal attenuation ratio in coronary CT angiography for the diagnosis of haemodynamically significant coronary artery stenosis. Br J Radiol 2020; 93:20190003. [DOI: 10.1259/bjr.20190003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: This study aimed to assess and compare the diagnostic performance of the coronary artery to aortic luminal attenuation ratio (CAR), transluminal attenuation gradient (TAG), and corrected coronary opacification (CCO) difference on coronary CT angiography (cCTA) for detecting haemodynamically significant coronary artery stenosis. Methods: 33 patients who underwent cCTA, gated SPECT myocardial perfusion imaging (MPI), and invasive coronary angiography within 3 months were included in this retrospective study. The degree of coronary stenosis on cCTA was visually assessed in all patients. Additionally, CAR, TAG, and CCO difference were analyzed and calculated in all patients. Haemodynamically significant coronary stenosis was defined as a vessel with ≥50% luminal stenosis on invasive coronary angiography and an associated abnormal perfusion defect on MPI in the same territory. Diagnostic performance was assessed on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). Results: Among 99 vessels, 12 were excluded and the remaining 87 were analyzed. 17 (19.5%) vessels were determined as haemodynamically significant coronary artery stenosis. On ROC analysis, the AUC was 0.71 for cCTA, 0.80 for CAR, 0.61 for TAG, 0.74 for CCO, 0.87 for combined CAR and cCTA, 0.77 for combined TAG and cCTA, and 0.75 for combined CCO and cCTA. The AUC for combined CAR and cCTA was significantly greater compared with cCTA alone (p < 0.01). Conclusion: Non-invasive CAR derived from 64-detector row CT was feasible and might be helpful for the detection of haemodynamically significant coronary artery stenosis. Still, further investigations such as intra- and inter-reader correlation, evaluation of larger numbers in different settings, and time efficiency are required for applying CAR in various situations. Advances in knowledge: CAR could be used as novel noninvasive technique to detect haemodynamically significant coronary artery stenosis.
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Affiliation(s)
- Tomofumi Misaka
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Yuki Sugitani
- Department of Cardiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, 630-0293, Japan
| | - Nobuyuki Asato
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Yuko Matsukubo
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Masanobu Uemura
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Ryuichiro Ashikaga
- Department of Radiology, Kindai University Nara Hospital, 1248‑1, Otoda‑cho, Ikoma, Nara, Japan
| | - Takayuki Ishida
- Department of Medical Physics and Engineering, Graduate School of Medicine, Osaka University 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Misaka T, Hosono M, Kudo T, Ito T, Syomura T, Uemura M, Okajima K. Influence of acquisition orbit on phase analysis of gated single photon emission computed tomography myocardial perfusion imaging for assessment of left ventricular mechanical dyssynchrony. Ann Nucl Med 2017; 31:235-244. [PMID: 28144811 DOI: 10.1007/s12149-017-1151-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/10/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The association between left ventricular (LV) dyssynchrony parameters, given by phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and acquisition orbits is unclear. The aim of this study was to assess the dependence of LV dyssynchrony parameters on acquisition orbits. METHODS Ninety-nine patients who underwent 201Tl-gated SPECT MPI were categorized into minor hypoperfusion or major hypoperfusion groups. Forty-four patients who underwent 99mTc-tetrofosmin-gated SPECT MPI were categorized into minor hypoperfusion or major hypoperfusion groups. The major hypoperfusion group with 201Tl was divided into inferior or non-inferior wall hypoperfusion subgroups, and anteroseptal or non-anteroseptal wall hypoperfusion subgroups. Gated SPECT MPI data over a 360° acquisition orbit (360° images) and a 180° acquisition orbit (180° images) were reconstructed, and histogram bandwidth (HBW) and phase standard deviation (PSD) were compared. RESULTS Between 360° and 180° images with 201Tl, there were significant differences in HBW and PSD both globally (HBW 34.8 ± 16.6 vs. 29.1 ± 10.2; PSD 8.8 ± 4.9 vs. 7.0 ± 2.3, p < 0.05 for both) and in the inferior wall (HBW 29.5 ± 15.5 vs. 23.3 ± 9.0; PSD 7.6 ± 4.6 vs. 5.6 ± 2.4, p < 0.001 for both) in the major hypoperfusion group, and also in the inferior wall in all subgroups of the major hypoperfusion group. In contrast, no segment had any significant differences in HBW or PSD between 360° and 180° images with 99mTc. CONCLUSION Differences in acquisition orbit had a significant influence on HBW and PSD with 201Tl-gated SPECT MPI in the inferior wall in patients with major hypoperfusion myocardium.
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Affiliation(s)
- Tomofumi Misaka
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Makoto Hosono
- Faculty of Medicine, Institute of Advanced Clinical Medicine, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, Nagasaki, Japan
| | - Takamichi Ito
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Tsutomu Syomura
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Masanobu Uemura
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
| | - Kaoru Okajima
- Department of Radiology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara, Japan
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Chikamori T, Hida S, Tanaka N, Igarashi Y, Yamashita J, Shiba C, Murata N, Hoshino K, Hokama Y, Yamashina A. Diagnostic Performance of a Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography System With Low-Dose Technetium-99m as Assessed by Fractional Flow Reserve. Circ J 2016; 80:1217-24. [DOI: 10.1253/circj.cj-16-0087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | | | - Chie Shiba
- Department of Cardiology, Tokyo Medical University
| | | | - Kou Hoshino
- Department of Cardiology, Tokyo Medical University
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
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Nakata T, Hashimoto A. Improved Prediction of Major Cardiac Events by Gated Myocardial Perfusion Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nanasato M, Nakajima K, Fujita H, Zen K, Kohsaka S, Hashimoto A, Moroi M, Fukuzawa S, Chikamori T, Nishimura S, Yamashina A, Kusuoka H, Hirayama A, Nishimura T. Rationale and design of J-ACCESS 4: prognostic impact of reducing myocardial ischemia identified using ECG-gated myocardial perfusion SPECT in Japanese patients with coronary artery disease. J Cardiol 2013; 63:159-64. [PMID: 24012330 DOI: 10.1016/j.jjcc.2013.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/25/2013] [Accepted: 07/23/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The findings of our recent study entitled, "Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS)" showed that myocardial perfusion single photon emission computed tomography (MPS) can detect coronary artery disease (CAD) and help to predict future cardiac events in patients with suspected or extant CAD. However, the extent of the benefit conferred by percutaneous coronary intervention (PCI) as an initial management strategy compared with optimal medical therapy remains controversial. Little evidence supports the notion that myocardial ischemia identified using MPS is an alternative target of coronary revascularization to reduce the likelihood of developing cardiac events. METHODS The multicenter, prospective cohort J-ACCESS 4 study aims to clarify the prognostic impact of reducing myocardial ischemia determined using electrocardiogram-gated MPS in Japanese patients with coronary artery disease. We started to register patients in J-ACCESS 4 at 74 facilities during June 2012 and will continue to do so until December 2013 or until the cohort comprises 500 patients who will participate in the study from one month before, until two months after stress/rest MPS assessment. Imaging data, the background of the patients including coronary risk factors and treatment before MPS assessments will be analyzed. The patients will undergo coronary revascularization within two months after MPS and/or receive appropriate medical therapy. The second stress/rest MPS will be performed from 4 to 10 months after coronary revascularization or registration. They will be followed up for over one year after the second MPS assessment. The primary endpoints will be cardiac death, sudden death of unknown cause, non-fatal myocardial infarction, and hospitalization for heart failure. The secondary endpoints will comprise death due to all causes including non-cardiac death and any cardiovascular events. This study will be completed in 2015. Here, we describe the design of the J-ACCESS 4 study.
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Affiliation(s)
- Mamoru Nanasato
- Cardiovascular Center, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, Ishikawa, Japan
| | - Hiroshi Fujita
- Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Kan Zen
- Division of Cardiology, Department of Medicine, Ohmihachiman Community Medical Center, Shiga, Japan
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akiyoshi Hashimoto
- Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shigeru Fukuzawa
- Division of Cardiology, Funabashi Municipal Medical Center, Chiba, Japan
| | | | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Prognostic value of myocardial perfusion imaging for cardiovascular events among asymptomatic Japanese patients with type 2 diabetes and mild renal dysfunction. Nucl Med Commun 2013; 34:328-32. [PMID: 23376861 DOI: 10.1097/mnm.0b013e32835e89ab] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Diabetes is frequently accompanied by chronic kidney disease, and both diabetes and chronic kidney disease are risk factors for ischemic heart disease; however, cardiac risk among diabetic patients with mild renal dysfunction has not been analyzed in detail. The present study investigates how myocardial perfusion imaging (MPI) contributes to the risk stratification of diabetic patients with mild renal dysfunction who are asymptomatic for cardiac diseases. PATIENTS AND METHODS Among 513 asymptomatic patients with type 2 diabetes in the Japanese Assessment of Cardiac Events and Survival Study 2 (J-ACCESS) database, we selected 286 with estimated glomerular filtration rates (eGFR) of at least 45 ml/min/1.73 m and assigned them to groups on the basis of eGFR of at least 60 without (group A, n=66) or with microalbuminuria or eGFR 45 to less than 60 (group B, n=220). The 3-year incidence of cardiac events and the value of MPI were evaluated. RESULTS Cardiac events developed in 1.52 and 4.55% of patients in groups A and B, respectively. Event-free survival did not differ according to summed stress scores in group A but was significantly lower among patients with summed stress scores of at least 9 in group B. CONCLUSION Routine MPI might be useful for stratifying risk among diabetic patients with mild renal dysfunction but is unnecessary for those with good renal function.
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Chapter 4: Other complications of CKD: CVD, medication dosage, patient safety, infections, hospitalizations, and caveats for investigating complications of CKD. Kidney Int Suppl (2011) 2013; 3:91-111. [PMID: 25599000 PMCID: PMC4284425 DOI: 10.1038/kisup.2012.67] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Moroi M, Yamashina A, Tsukamoto K, Nishimura T. Coronary revascularization does not decrease cardiac events in patients with stable ischemic heart disease but might do in those who showed moderate to severe ischemia. Int J Cardiol 2011; 158:246-52. [PMID: 21342709 DOI: 10.1016/j.ijcard.2011.01.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 01/10/2011] [Accepted: 01/13/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND As an initial management strategy for stable ischemic heart disease (IHD), coronary revascularization therapy is thought to be equal to optimal medical therapy alone regarding prognosis. METHODS Whether or not the effects of revascularization on the prognosis of patients with stable IHD are associated with the amount of ischemic myocardium detected by nuclear stress imaging was evaluated. This retrospective study analyzed data from 4629 patients with suspected or known IHD who underwent gated stress myocardial-perfusion SPECT at 117 hospitals in Japan. The follow-up periods were three years and the combined endpoints consisted of cardiac death, nonfatal myocardial infarction, and congestive heart failure requiring hospitalization. After matching propensity scores between patients who underwent early revascularization and those who did not (n=316 per group), we compared cardiac event rates in relation to the amount of ischemic myocardium. RESULTS Cardiac event rates did not significantly differ between patients who underwent early revascularization and those who did not (5.4% vs. 6.4%). Among patients with ≤ 5%, 6-10%, and >10% ischemic myocardium, cardiac event rates were 8%, 3% and 0% respectively, who underwent early revascularization compared with 4.5%, 6.1%, and 12.3%, respectively, among those who did not. Cardiac event rates were significantly lower among patients with >10% ischemic myocardium who underwent early revascularization compared with those who did not (0% vs. 12.3%, p=0.0062). CONCLUSIONS Coronary revascularization for stable IHD does not decrease major cardiac events in all patients but might do in patients with moderate to severe ischemia.
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Affiliation(s)
- Masao Moroi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
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Nakamura S, Kawano Y, Hase H, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H, Takeishi Y, Nakajima K, Momose M, Takehana K, Nanasato M, Yoda S, Nishina H, Matsumoto N, Nishimura T. Prognostic study of cardiac and renal events in Japanese patients with chronic kidney disease and cardiovascular risk using myocardial perfusion SPECT: J-ACCESS 3 study design. Ther Apher Dial 2010; 14:379-85. [PMID: 20649758 DOI: 10.1111/j.1744-9987.2010.00823.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease. Recent studies have indicated that the incidence of cardiovascular disease increases inversely with estimated glomerular filtration rate. Although coronary angiography is considered the gold standard for detecting coronary artery disease, contrast-induced nephropathy or cholesterol microembolization remain serious problems; therefore, a method of detecting coronary artery disease without renal deterioration is desirable. From this viewpoint, stress myocardial perfusion single photon emission computed tomography (SPECT) might be useful for patients with chronic kidney disease. We recently performed the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) investigating patients with suspected or extant coronary artery disease and the J-ACCESS 2 study of patients with diabetes. The findings from these studies showed that SPECT can detect coronary artery disease and help to predict future cardiac events. Thus, we proposed a multicenter, prospective cohort study called "J-ACCESS 3" in patients with chronic kidney disease and cardiovascular risk. The study aimed at predicting cardiovascular and renal events based on myocardial perfusion imaging and clinical backgrounds. We began enrolling patients in J-ACCESS 3 at 74 facilities from April 2009 and will continue to do so until 31 March 2010, with the aim of having a cohort of 800 patients. These will be followed up for three years. The primary endpoints will be cardiac death and sudden death. The secondary endpoints will comprise any cardiovascular or renal events. This study will be completed in 2013. Here, we describe the design of the J-ACCESS 3 study.
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Affiliation(s)
- Satoko Nakamura
- Department of Medicine, Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Japan
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Muramatsu T, Nishimura S, Yamashina A, Nishimura T. Relation between prognosis and myocardial perfusion imaging from the difference of end-point criterion for exercise stress testing: A sub-analysis of the J-ACCESS study. J Cardiol 2010; 56:51-8. [DOI: 10.1016/j.jjcc.2010.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/29/2010] [Accepted: 02/08/2010] [Indexed: 11/25/2022]
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Usui Y, Chikamori T, Nakajima K, Hida S, Yamashina A, Nishimura T. Prognostic value of post-ischemic stunning as assessed by gated myocardial perfusion single-photon emission computed tomography: a subanalysis of the J-ACCESS study . Circ J 2010; 74:1591-9. [PMID: 20571246 DOI: 10.1253/circj.cj-10-0074] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the prognostic value of post-ischemic stunning, the Japanese assessment of cardiac event and survival study by quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) study was reevaluated. METHODS AND RESULTS Of the 4,031 patients of the J-ACCESS, the present study evaluated 1,089 who completed gated SPECT both after stress and at rest. To assess post-ischemic stunning, the following measurements (left ventricular volumes after stress minus volumes at rest) were made: Deltaend-systolic volume (DeltaESV), Deltaenddiastolic volume (DeltaEDV) and Deltaejection fraction (DeltaEF). Myocardial stunning defined either as DeltaESV >or=5 ml, DeltaEDV >or=5 ml or DeltaEF <or=5% was observed in 21%, 22%, or 26%, respectively. During a 3-year follow-up, 101 cardiac events occurred. Kaplan-Meier survival estimation indicated worse event-free survival rates in patients with dilated ESV, dilated EDV, LVEF <or=45%, DeltaESV >or=5 ml or DeltaEDV >or=5 ml than in those without, whereas DeltaEF <or=5% did not predict events. Multivariate analysis demonstrated that LVEF <or=45% was the independent predictor for cardiac events. Nevertheless, DeltaEDV >or=5 ml was also an independent parameter, in addition to LVEF <or=45%, to predict the combined endpoint of cardiac death, myocardial infarction, and revascularization, but excluding heart failure. CONCLUSIONS These results indicate that post-ischemic stunning, as assessed by gated SPECT, is a marker for poor prognosis, particularly for ischemic cardiac events.
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Affiliation(s)
- Yasuhiro Usui
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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Nakata T, Hashimoto A, Wakabayashi T, Kusuoka H, Nishimura T. Prediction of new-onset refractory congestive heart failure using gated myocardial perfusion SPECT imaging in patients with known or suspected coronary artery disease subanalysis of the J-ACCESS database. JACC Cardiovasc Imaging 2010; 2:1393-400. [PMID: 20083074 DOI: 10.1016/j.jcmg.2009.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 09/16/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the predictive value of perfusion/function parameters measured by gated myocardial perfusion single-photon emission computed tomography (SPECT)in combination with clinical variables in patients with known or suspected coronary artery disease to predict refractory heart failure (HF). BACKGROUND The increasing number of HF patients requires the establishment of a prophylactic strategy that can identify patients at high risk of HF due to coronary artery disease. METHODS We analyzed clinical and stress/rest-gated SPECT data from the multicenter, prospective, and observational J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) database of 3,835 known or suspected coronary artery disease patients in which new-onset congestive HF symptoms requiring aggressive medical treatment were observed in 71 patients for 3 years. RESULTS The multivariable Cox hazard model revealed that chronic renal dysfunction (hazard ratio(HR): 6.227 [95% confidence interval (CI): 2.920 to 13.279]), the end-systolic volume index (ESVI) (HR:1.019 [95% CI: 1.011 to 1.029]), and moderate to high stress summed score (SSS) (HR: 3.012 [95% CI: 1.757 to 5.181]) independently (p < 0.0001) predicted HF. In addition to the close (p < 0.0001) correlation of ESVI and SSS with HF incidence, the combined tertiles of SSS and ESVI revealed high-risk patients with a maximally 17.3 times greater risk (5.2%/3 years) compared with the minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI. Chronic renal dysfunction combined with ESVI and SSS categories had the greatest (p < 0.005 to 0.001) incremental prognostic value with a global chi-square value (125.0)over single or other combined risks. CONCLUSIONS Chronic renal dysfunction, greater stress-induced perfusion abnormality, and higher ESVI provide independent and additive information for predicting the risk of refractory HF in known or suspected coronary patients, indicating the efficacy of perfusion/function parameters measured by stress gated perfusion SPECT for identifying patients at greater risk of future refractory HF.
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Clinical significance of ischemic electrocardiographic changes during stress myocardial perfusion imaging: sub-analysis of the J-ACCESS study. Ann Nucl Med 2010; 24:215-24. [DOI: 10.1007/s12149-010-0346-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 01/18/2010] [Indexed: 11/25/2022]
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21
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Ueshima K, Yamashina A, Usami S, Yasuno S, Nishiyama O, Yamazaki T, Nakao K, Nishimura T. Prognostic value of myocardial perfusion SPECT images in combination with the maximal heart rate at exercise testing in Japanese patients with suspected ischemic heart disease: a sub-analysis of J-ACCESS. Ann Nucl Med 2009; 23:849-54. [PMID: 19898922 DOI: 10.1007/s12149-009-0315-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 09/10/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We assessed whether a combination of summed stress scores (SSS) using exercise myocardial perfusion SPECT (Ex-SPECT) and maximal heart rate accurately predicts cardiac events through a sub-analysis of J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) which was conducted to evaluate the prognosis of Japanese patients with suspected ischemic heart disease. METHODS In J-ACCESS, 2,373 patients with suspected coronary artery disease not receiving beta-blocker treatment underwent Ex-SPECT. These patients were categorized into the following four groups: Group A [achieved target heart rate (THR) and SSS < 4: n = 631], B (did not achieve THR and SSS < 4: n = 612), C (achieved THR and SSS >or= 4: n = 570), and D (did not achieve THR and SSS >or= 4: n = 560). We evaluated the incidence rate of cardiac events including cardiac death, myocardial infarction, and heart failure requiring hospital admission during a 3-year period. RESULTS In Group A, B, C, and D, 9 of 631 (1.4%), 15 of 612 (2.4%), 23 of 570 (4.0%) and 30 of 560 (5.4%) patients experienced cardiac events, respectively. Although the hazard ratio of the SSS >or= 4 was 2.45 (p < 0.001) and that of the attained THR was 0.69 (p = 0.10) in the multiple Cox regression analysis, Kaplan-Meier curves showed that the cardiac events rate was lower in the order of A, B, C, and D (p < 0.001). CONCLUSION The combination of SSS using Ex-SPECT and the maximal heart rate is a useful predictor of cardiac events in patients with suspected coronary artery disease.
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Affiliation(s)
- Kenji Ueshima
- EBM Research Center, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.
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22
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Imamura Y, Fukuyama T, Nishimura S, Nishimura T. Normal myocardial perfusion scan portends a benign prognosis independent from the pretest probability of coronary artery disease. Sub-analysis of the J-ACCESS study. J Cardiol 2009; 54:93-100. [DOI: 10.1016/j.jjcc.2009.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/26/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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Igarashi Y, Chikamori T, Hida S, Nagao T, Tanaka H, Usui Y, Hatano T, Morishima T, Yanagisawa H, Yamashina A. Comparative impact of scintigraphic parameters and B-type natriuretic peptide for the prediction of major cardiac events in the QGS-prognostic value in the elderly (Q-PROVE) study. Circ J 2009; 73:1655-60. [PMID: 19638709 DOI: 10.1253/circj.cj-09-0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although B-type natriuretic peptide (BNP) has emerged as an important predictor for cardiac events, its effect on scintigraphic parameters is unknown. METHODS AND RESULTS The Q-PROVE study is a multicenter study to evaluate the prognostic value of ECG-gated SPECT in 175 Japanese elderly patients. In addition, BNP was assessed in 102 patients. Outcome assessment included cardiac events and noncardiac deaths. Twelve elderly patients (12%) had increased BNP >130 pg/ml. The summed stress score (SSS) was greater in patients with increased BNP than in those with normal BNP. Kaplan-Meier survival estimation indicated event-free survival rates at 3 years of 83%, 78%, 88%, 80%, respectively, in patients with BNP >130 pg/ml, SSS >or=7, summed difference score (SDS) >or=2, and dilated end-diastolic volume (EDV), but 98%, 98%, 100%, 94% in those with BNP <or=130 pg/ml, SSS <7, SDS <2 and normal EDV (P=0.006, P=0.005, P=0.0008, P=0.01). Multivariate analysis demonstrated that an SDS was the only independent predictor for subsequent cardiac events (hazard ratio =4.0, P=0.04). CONCLUSIONS Although BNP may have similar prognostic value to gated SPECT volumetric measurements in elderly patients with known or suspected coronary artery disease, myocardial ischemia as documented by SPECT is still indispensable for detecting high-risk patients compared with BNP alone.
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Affiliation(s)
- Yuko Igarashi
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
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Hatta T, Nishimura S, Nishimura T. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease. Eur J Nucl Med Mol Imaging 2009; 36:1835-41. [PMID: 19471925 DOI: 10.1007/s00259-009-1165-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Accepted: 05/01/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to identify useful predictors of cardiac events in patients with chronic kidney disease (CKD). METHODS Among 4,031 patients identified from the Japanese Assessment of Cardiac Events and Survival Study (J-ACCESS) database with suspected or known ischaemic heart disease, we selected 820 with an estimated glomerular filtration rate (eGFR) of < 60 ml/min per 1.73 m(2). RESULTS A total of 75 cardiac events developed among these 820 patients. The incidence of cardiac events was higher in the group with a lower eGFR. Multivariate Cox analysis indicated that age, diabetes mellitus, end-systolic volume, summed stress score (SSS) and eGFR were predictors of cardiac events. Event rates of patients with SSS >or= 9 were significantly higher in groups with lower eGFR values (< 40 and 40-49 ml/min). CONCLUSION The SSS value (>or= 9) is a reliable predictor of cardiac events and myocardial single photon emission computed tomography has incremental value for predicting cardiac events and survival in CKD.
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Affiliation(s)
- Tsuguru Hatta
- Division of Nephrology, Department of Medicine, Ohmihachiman Community Medical Center, Ohmihachiman-Shi, Shiga 523-0082, Japan.
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25
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Nakajima K, Kusuoka H, Nishimura S, Yamashina A, Nishimura T. Prognostic value of myocardial perfusion and ventricular function in a Japanese multicenter cohort study (J-ACCESS): the first-year total events and hard events. Ann Nucl Med 2009; 23:373-81. [DOI: 10.1007/s12149-009-0248-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/19/2009] [Indexed: 10/20/2022]
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Prognostic significance of stress myocardial gated SPECT among Japanese patients referred for coronary angiography: A study of data from the J-ACCESS database. Eur J Nucl Med Mol Imaging 2009; 36:1329-37. [PMID: 19221740 DOI: 10.1007/s00259-009-1084-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 01/23/2009] [Indexed: 01/19/2023]
Abstract
PURPOSE The J-ACCESS [Japanese investigation of prognosis based on gated single photon emission computed tomography (SPECT)] study found that quantitative gated myocardial SPECT (QGS) is valuable for predicting the prognosis of Japanese patients with known or suspected ischaemic heart disease. The present study evaluates the incremental prognostic value of myocardial perfusion imaging (MPI) with QGS among patients referred for coronary angiography (CAG). METHODS Among 4,031 Japanese patients registered at 117 hospitals for the J-ACCESS study, we selected 1,011 who underwent CAG within 3 months before or after MPI with QGS. Summed stress, rest and difference scores (SSS, SRS and SDS) were generated from myocardial perfusion images using a 20-segment scoring system. Myocardial ischaemia was judged visually. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were determined by QGS. Numbers of diseased (> 75% stenosis) coronary vessels (CDV) were assessed by CAG. All patients were followed up for 3 years to determine cardiac events (CE) including cardiac death, non-fatal myocardial infarction and severe heart failure. Univariate and multivariate analyses of prognostic ability included age, cardiac risk factors (hypertension, hyperlipidaemia, diabetes mellitus and prior myocardial infarction), angiographic findings and the QGS parameters as independent variables. RESULTS Cardiac events occurred more frequently with increasing numbers of coronary vessel lesions (p = 0.0016). Cox univariate analysis revealed that diabetes, CDV, SSS, SDS, EDV, ESV and EF were significant predictors (Wald chi(2) = 5.99, 12.9, 8.39, 9.11, 35.5, 42.1 and 31.1, respectively), whereas multivariate analysis selected only ESV and SDS as significant predictors (Wald chi(2) = 36.4, 8.4; p = 0.0038, p < 0.001). CONCLUSION MPI with QGS, especially with gated functional data, has incremental prognostic value in addition to angiographic findings. MPI with QGS findings predominantly contribute to the prediction of prognosis rather than numbers of diseased vessels assessed by CAG. Thus, MPI with QGS is the most useful tool with which to guide decisions regarding therapy even among patients referred for CAG.
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Nakajima K, Nishimura T. Prognostic table for predicting major cardiac events based on J-ACCESS investigation. Ann Nucl Med 2009; 22:891-7. [PMID: 19142708 DOI: 10.1007/s12149-008-0189-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 07/03/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The event risk of patients with coronary heart disease may be estimated by a large-scale prognostic database in a Japanese population. The aim of this study was to create a heart risk table for predicting the major cardiac event rate. METHODS Using the J-ACCESS database created by a prognostic investigation involving 117 hospitals and >4,000 patients in Japan, multivariate logistic regression analysis was performed. The major event rate over a 3-year period that included cardiac death, non-fatal myocardial infarction, and severe heart failure requiring hospitalization was predicted by the logistic regression equation. The algorithm for calculating the event rate was simplified for creating tables. RESULTS Two tables were created to calculate cardiac risk by age, perfusion score category, and ejection fraction with and without the presence of diabetes. A relative risk table comparing age-matched control subjects was also made. When the simplified tables were compared with the results from the original logistic regression analysis, both risk values and relative risks agreed well (P < 0.0001 for both). CONCLUSIONS The Heart Risk Table was created for patients suspected of having ischemic heart disease and who underwent myocardial perfusion gated single-photon emission computed tomography. The validity of risk assessment using a J-ACCESS database should be validated in a future study.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
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28
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Hashimoto A, Nakata T, Wakabayashi T, Kusuoka H, Nishimura T. Incremental Prognostic Value of Stress/Rest Gated Perfusion SPECT in Patients With Coronary Artery Disease Subanalysis of the J-ACCESS Study. Circ J 2009; 73:2288-93. [DOI: 10.1253/circj.cj-09-0212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Tomoaki Nakata
- Sapporo Medical University School of Medicine
- Hokkaido Prefectural Esashi Hospital
| | | | | | - Tsunehiko Nishimura
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Matsumoto N, Sato Y, Suzuki Y, Kasama S, Nakano Y, Kato M, Yoda S, Miki T, Iida J, Kunimasa T, Tadehara F, Nagao K, Hirayama A. Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J 2008; 72:2035-9. [PMID: 18948667 DOI: 10.1253/circj.cj-08-0488] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese. METHODS AND RESULTS The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9+/-15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors > or =2), significant ischemia (SDS > or =4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS. CONCLUSION Poststress EF added incremental prognostic value for the prediction of ACS.
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Affiliation(s)
- Naoya Matsumoto
- Department of Cardiology, Nihon University School of Medicine, Tokyo
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Surveillance study for creating the national clinical database relating to ECG-gated myocardial perfusion SPECT of asymptomatic ischemic heart disease in patients with type-2 diabetes mellitus: J-ACCESS 2 study design. Ann Nucl Med 2008; 22:13-21. [DOI: 10.1007/s12149-007-0079-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Accepted: 08/31/2007] [Indexed: 11/26/2022]
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Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging 2007; 35:319-28. [DOI: 10.1007/s00259-007-0608-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 09/15/2007] [Indexed: 10/22/2022]
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Nakajima K, Kusuoka H, Nishimura S, Yamashina A, Nishimura T. Normal limits of ejection fraction and volumes determined by gated SPECT in clinically normal patients without cardiac events: a study based on the J-ACCESS database. Eur J Nucl Med Mol Imaging 2007; 34:1088-96. [PMID: 17219133 DOI: 10.1007/s00259-006-0321-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Quantitative gated single-photon emission computed tomography (SPECT) is known to have high accuracy and precision for measurement of the principal cardiac functional parameters. We hypothesised that normal values for EF and LV volumes may differ among nationalities, and that optimal threshold values specific to the study population are required. METHODS Among 4,670 consecutively registered patients for a J-ACCESS (Japanese investigation regarding prognosis based on gated SPECT) study from 117 hospitals, a total of 268 (149 women, 119 men) were selected who had no baseline cardiac diseases and had experienced no cardiac events during the preceding 3-year period. A gated SPECT study was performed with 99mTc-tetrofosmin and analysed with Cedars Sinai Medical Center's quantitative gated SPECT (QGS) software. The results in respect of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) and stroke volume (SV), and EDV, ESV and SV normalised by body surface area (EDVI, ESVI and SVI), were calculated and summarised to obtain normal limits. RESULTS EF for women and men was 74 +/- 9% and 63 +/- 7%, respectively (p < 0.0001). EDV, ESV and SV were significantly smaller in women than in men. Based on multiple regressions for linear models, the primary and secondary predictors of EF, EDVI, ESVI were gender and age. By stepwise multiple regression analysis, a statistically significant third predictor for EDV, ESV, SV and SVI was body weight. No colinearity was found between age and body weight. Important factors for the studied Japanese population included a high incidence of small hearts in women and the relatively advanced age of the population (the mean age +/-SD was 64.1 +/- 10.0 years for women and 60.9 +/- 11.7 years for men). CONCLUSION EF and volumes determined by gated SPECT with QGS were significantly affected by gender and age, with body weight as a third predictor for volumes. Moreover, the normal limits were so specific for the population studied that standards appropriate for the study in question should be utilised.
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Affiliation(s)
- Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
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Matsuo S, Nakajima K, Horie M, Nakae I, Nishimura T, The J-ACCESS Investigators. Prognostic Value of Normal Stress Myocardial Perfusion Imaging in Japanese Population A Study Based on the J-ACCESS Study. Circ J 2007; 72:611-7. [DOI: 10.1253/circj.72.611] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinro Matsuo
- Department of Nuclear Medicine, Kanazawa University Hospital
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Ichiro Nakae
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Tsunehiko Nishimura
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Nagao T, Chikamori T, Hida S, Igarashi Y, Kuwabara Y, Nishimura S, Yamazaki J, Yamashina A. Quantitative Gated Single-Photon Emission Computed Tomography With 99mTc Sestamibi Predicts Major Cardiac Events in Elderly Patients With Known or Suspected Coronary Artery Disease The QGS-Prognostic Value in the Elderly (Q-PROVE) Study. Circ J 2007; 71:1029-34. [PMID: 17587706 DOI: 10.1253/circj.71.1029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although electrocardiogram-gated single-photon emission computed tomography (SPECT) may be useful in risk stratification of elderly patients with coronary artery disease (CAD), few studies have prospectively evaluated its prognostic value in this patient population. METHODS AND RESULTS A total of 175 patients aged 75 years or more with known or suspected CAD were prospectively evaluated by stress gated SPECT using a 20-segment model and an automatic functional analysis. Patients with acute coronary syndrome within the previous 3 months, and those who underwent coronary revascularization within 3 months after the SPECT study were excluded. Outcome assessment included prespecified cardiac events and noncardiac deaths. During a mean follow-up of 3.4 years, there were 18 cardiac events: 2 cardiac deaths, 1 nonfatal myocardial infarction, 3 coronary artery bypass grafting, 5 percutaneous coronary interventions, 1 unstable angina, 4 heart failures, and 2 malignant arrhythmias. Kaplan-Meier survival estimation indicated an event-free survival rate of 98.1% at 3 years in patients without myocardial ischemia, but 79.9% in those with ischemia as documented by gated SPECT (p=0.0001). Multivariate analysis using the Cox proportional hazard model demonstrated that stress-induced myocardial ischemia was the only independent predictor for subsequent cardiac events (p<0.01). CONCLUSIONS Stress gated SPECT predicts cardiac events in patients aged 75 years or more with known or suspected CAD and may have a role in risk stratification of this patient population.
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Affiliation(s)
- Tadashi Nagao
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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