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Assante R, Zampella E, D'Antonio A, Mannarino T, Gaudieri V, Nappi C, Arumugam P, Panico M, Buongiorno P, Petretta M, Cuocolo A, Acampa W. Impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic perfusion defect and myocardial flow reserve. Eur J Nucl Med Mol Imaging 2024; 51:1612-1621. [PMID: 38191816 PMCID: PMC11043198 DOI: 10.1007/s00259-023-06588-4] [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: 10/17/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE We evaluated the impact on cardiovascular outcome of coronary revascularization-induced changes in ischemic total perfusion defect (ITPD) and myocardial flow reserve (MFR) as assessed by 82Rb positron emission tomography (PET)/computed tomography (CT) imaging. METHODS The study included 102 patients referred to 82Rb PET/CT myocardial perfusion imaging before and after coronary revascularization. All patients were followed for the occurrence of cardiovascular events (cardiac death, nonfatal myocardial infarction, repeated revascularization, and heart failure) after the second imaging study. RESULTS During a median follow-up of 20 months, 21 events occurred. The clinical characteristics were comparable between patients with and without events. In the overall study population, after revascularization, there was a significant reduction (P < 0.001) of ITPD, while hyperemic myocardial blood flow (MBF) (P < 0.01) and MFR (P < 0.05) significantly improved. Event rate was higher in patients with ITPD (P < 0.005) or MFR (P < 0.001) worsening compared to those with unchanged or improved ITPD or MFR. At Cox univariable analysis, ITPD and MFR worsening resulted in predictors of events (both P < 0.05). Patients with worsening of both ITPD and MFR had the worst event-free survival (log-rank 32.9, P for trend < 0.001). CONCLUSIONS In patients with stable CAD, worsening of ITPD and MFR after revascularization procedures is associated with higher risk of cardiovascular events. Follow-up MPI with 82Rb PET/CT may improve risk stratification in patients submitted to coronary revascularization.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Adriana D'Antonio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Parthiban Arumugam
- Department of Nuclear Medicine, Central Manchester Foundation Trust, Manchester, UK
| | | | - Pietro Buongiorno
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | | | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
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Cho SW, Yang JH, Park TK, Lee JM, Song YB, Hahn JY, Choi JH, Gwon HC, Lee SH, Choi SH. Clinical Implications of Early Exercise Treadmill Testing after Percutaneous Coronary Intervention in the Drug-eluting Stent Era. J Korean Med Sci 2020; 35:e229. [PMID: 32657087 PMCID: PMC7358060 DOI: 10.3346/jkms.2020.35.e229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limited data are available on the clinical meaning of early routine exercise treadmill testing (ETT) after percutaneous coronary intervention (PCI) in the drug-eluting stent era. We aimed to determine the clinical utility and implications of early routine ETT after PCI. METHODS This was a single-center, prospective cohort study. A total of 776 patients underwent ETT within 3 months after index PCI were analyzed. We classified patients into ETT positive (+) and negative (-) groups and compared major adverse cardiac events (MACE) including all-cause death, myocardial infarction, and coronary revascularization. RESULTS The median follow-up duration was 19.6 months (interquartile range, 15.4 to 33.5 months). ETT was positive for 63 patients (17.1%) with single-vessel disease (VD) and 150 patients (36.9%) with multi-VD. Previous PCI, absence of thrombotic lesion, multi-VD, and residual Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score > 8 were independent predictors of ETT (+). Compared with the ETT (-) group, the ETT (+) group was associated with increased risk of MACE for patients with single-VD (18.1% vs. 52.3%; adjusted hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.10-6.49; P = 0.03) and residual SYNTAX score ≤ 8 (26.5% vs. 42.1%; adjusted HR, 1.90; 95% CI, 1.09-3.30; P = 0.02), but not for patients with multi-VD and residual SYNTAX score > 8. CONCLUSION Early routine ETT after PCI might be helpful for predicting clinical outcomes in patients with single-VD and residual SYNTAX score ≤ 8 but not multi-VD and residual SYNTAX score > 8.
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Affiliation(s)
- Sung Woo Cho
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Ricciardi C, Cantoni V, Improta G, Iuppariello L, Latessa I, Cesarelli M, Triassi M, Cuocolo A. Application of data mining in a cohort of Italian subjects undergoing myocardial perfusion imaging at an academic medical center. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 189:105343. [PMID: 31981760 DOI: 10.1016/j.cmpb.2020.105343] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Coronary artery disease (CAD) is still one of the primary causes of death in the developed countries. Stress single-photon emission computed tomography is used to evaluate myocardial perfusion and ventricular function in patients with suspected or known CAD. This study sought to test data mining and machine learning tools and to compare some supervised learning algorithms in a large cohort of Italian subjects with suspected or known CAD who underwent stress myocardial perfusion imaging. METHODS The dataset consisted of 10,265 patients with suspected or known CAD. The analysis was conducted using Knime analytics platform in order to implement Random Forests, C4.5, Gradient boosted tree, Naïve Bayes, and K nearest neighbor (KNN) after a procedure of features filtering. K-fold cross-validation was employed. RESULTS Accuracy, error, precision, recall, and specificity were computed through the above-mentioned algorithms. Random Forests and gradients boosted trees obtained the highest accuracy (>95%), while it was comprised between 83% and 88%. The highest value for sensitivity and specificity was obtained by C4.5 (99.3%) and by Gradient boosted tree (96.9%). Naïve Bayes had the lowest precision (70.9%) and specificity (72.0%), KNN the lowest recall and sensitivity (79.2%). CONCLUSIONS The high scores obtained by the implementation of the algorithms suggests health facilities consider the idea of including services of advanced data analysis to help clinicians in decision-making. Similar applications of this kind of study in other contexts could support this idea.
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Affiliation(s)
- Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
| | - Valeria Cantoni
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Luigi Iuppariello
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Imma Latessa
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Mario Cesarelli
- DIETI, University of Naples 'Federico II', Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS; Telese Terme (BN), Italy.
| | - Maria Triassi
- Department of Public Health, University Hospital of Naples 'Federico II', Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Naples, Italy
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4
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Andrade LFD, Souza AC, Peclat T, Bartholo C, Pavanelo T, Lima RDSL. The Prognostic Value and Clinical Use of Myocardial Perfusion Scintigraphy in Asymptomatic Patients after Percutaneous Coronary Intervention. Arq Bras Cardiol 2018; 111:784-793. [PMID: 30517374 PMCID: PMC6263458 DOI: 10.5935/abc.20180199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/02/2018] [Indexed: 01/18/2023] Open
Abstract
Background The role of myocardial perfusion scintigraphy (MPS) in the follow-up of
asymptomatic patients after percutaneous coronary intervention (PCI) is not
established. Objectives To evaluate the prognostic value and clinical use of MPS in asymptomatic
patients after PCI. Methods Patients who underwent MPS consecutively between 2008 and 2012 after PCI were
selected. The MPS were classified as normal and abnormal, the perfusion
scores, summed stress score (SSS), and summed difference score (SDS) were
calculated and converted into percentage of total perfusion defect and
ischemic defect. The follow-up was undertaken through telephone interviews
and consultation with the Mortality Information System. Primary endpoints
were death, cardiovascular death, and nonfatal acute myocardial infarction
(AMI), and secondary endpoint was revascularization. Logistic regression and
COX method were used to identify the predictors of events, and the value of
p < 0.05 was considered statistically significant. Results A total of 647 patients were followed for 5.2 ± 1.6 years. 47% of MPS
were normal, 30% were abnormal with ischemia, and 23% were abnormal without
ischemia. There were 61 deaths, 27 being cardiovascular, 19 non-fatal AMI,
and 139 revascularizations. The annual death rate was higher in those with
abnormal perfusion without ischemia compared to the groups with ischemia and
normal perfusion (3.3% × 2% × 1.2%, p = 0.021). The annual
revascularization rate was 10.3% in the ischemia group, 3.7% in those with
normal MPS, and 3% in those with abnormal MPS without ischemia. The
independent predictors of mortality and revascularization were,
respectively, total perfusion defect greater than 6%, and ischemic defect
greater than 3%. Forty-two percent of the patients underwent MPS less than 2
years after PCI, and no significant differences were observed in relation to
those who underwent it after that period. Conclusion Although this information is not contemplated in guidelines, in this study
MPS was able to predict events in asymptomatic after PCI patients,
regardless of when they were performed.
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Affiliation(s)
- Larissa Franco de Andrade
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil.,Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brazil
| | - Ana Carolina Souza
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
| | - Thais Peclat
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
| | - Caio Bartholo
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
| | - Thalita Pavanelo
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil
| | - Ronaldo de Souza Leão Lima
- Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brazil.,Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brazil
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Petretta M, Cuocolo A. Comparison of ESC and ACC/AHA guidelines for myocardial revascularization: are the differences clinically relevant? The European perspective. J Nucl Cardiol 2017; 24:1057-1061. [PMID: 28432668 DOI: 10.1007/s12350-017-0885-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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6
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Cuocolo A, Taillefer R. Serial cardiac SPECT studies: Technical issues and clinical implications. J Nucl Cardiol 2016; 23:1454-1456. [PMID: 27796848 DOI: 10.1007/s12350-016-0703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Raymond Taillefer
- Department of Radiology, Radio-oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada
- Department of Nuclear Medicine, l'Hôpital du Haut-Richelieu, Saint-Jean-sur-Richelieu, Canada
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7
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Marini C, Acampa W, Bauckneht M, Daniele S, Capitanio S, Cantoni V, Fiz F, Zampella E, Dib B, Assante R, Bruzzi P, Sambuceti G, Cuocolo A. Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity. Eur J Nucl Med Mol Imaging 2014; 42:750-60. [PMID: 25476258 DOI: 10.1007/s00259-014-2963-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD). METHODS AND RESULTS We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2-4) in 180, moderate (SDS 5-7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information. CONCLUSION Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimaging and Molecular Physiology, Section of Genoa c/o Nuclear Medicine, Pad. Sommariva, IRCCS AOU San Martino-National Institute for Cancer Research, L.go R. Benzi, 10, 16132, Genoa, Italy,
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8
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Cardiac Radionuclide Imaging After Coronary Artery Revascularization. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-013-9255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Lima R, Ronaldo L, De Lorenzo A, Andrea DL, Camargo G, Gabriel C, Oliveira G, Gabriel O, Reis T, Thiago R, Peclat T, Thais P, Rothstein T, Tamara R, Gottlieb I, Ilan G. Prognostic value of myocardium perfusion imaging with a new reconstruction algorithm. J Nucl Cardiol 2014; 21:149-57. [PMID: 24281904 DOI: 10.1007/s12350-013-9824-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND It has been demonstrated that a new reconstruction algorithm for myocardium perfusion imaging (MPI) allows faster acquisition with similar accuracy. The prognostic value of MPI performed with this software and short acquisition time is unknown. METHODS To determine the prognostic value we followed 3184 consecutive MPI patients between March 2008 and March 2010. A 2-day protocol with low dose 99mTc-MIBI (10-12 mCi) and a 6-minute acquisition was used. Exercise stress was used in 62.6% of the studies. Scans were reconstructed using the software "Evolution for cardiac". Perfusion defects were quantified by summed stress score (SSS) and categorized in four groups: SSS0 = 0; SSS1 = 1-3; SSS2 = 4-8; and SSS3 ≥ 9. Patients were phone contacted every 6 months for follow up and hard events were defined as death or myocardial infarction (MI) and total events as hard events plus late revascularization. RESULTS The mean radiation dose was <7 mSv/patient. Mean F/U was 33 ± 20 months; 140 of the patients were lost to follow up and 86 were censored due early revascularization (<60 days after MPS). There were 140 hard events: 89 deaths and 51 MI. Mean age was 61.5 ± 12.3 years and 57.7% were male. Hard event rate was 0.8%/year in patients with normal MPS and 3.7%/year in those with abnormal MPS. Patients with larger defects had nine times more hard events than patients with SSS = 0 (14.2% vs 1.6%). Revascularization was more frequent in patients with abnormal MPS than normal MPS (21.7% vs 3.9%; P < 0.001). Cox proportional hazard analysis showed that SSS was an independent predictor of hard events and revascularization. CONCLUSIONS The use of reduced-dose, fast myocardial perfusion SPECT and the new processing algorithm lowers acquisition time and radiation exposure compared to conventional SPECT without compromising the well-established prognostic value of MPI.
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Affiliation(s)
| | - Lima Ronaldo
- Universidade Federal do Rio de Janeiro, Cardiology, Rio de Janeiro, Brazil,
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10
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Schepis T, Benz K, Haldemann A, Kaufmann PA, Schmidhauser C, Frielingsdorf J. Prognostic value of stress-gated 99m-technetium SPECT myocardial perfusion imaging: risk stratification of patients with multivessel coronary artery disease and prior coronary revascularization. J Nucl Cardiol 2013; 20:755-62. [PMID: 23839243 DOI: 10.1007/s12350-013-9749-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study assessed the prognostic value of stress-gated 99mTc-sestamibi myocardial perfusion SPECT (MPS) in patients with multivessel coronary artery disease (CAD) and prior revascularization according to the presence and severity of ischemia. METHODS AND RESULTS We studied the outcome of 472 patients with multivessel CAD and prior revascularization (coronary angioplasty, 290 patients; bypass surgery, 182 patients), who underwent exercise or dipyridamole 99mTc-sestamibi MPS for evaluation of ischemia. Visual scoring of perfusion images used 20 segments and a 5-point scale. Gated post-stress EF was automatically calculated. Endpoints included hard events: cardiac death (CD) and nonfatal myocardial infarction (MI). During a mean follow-up of 3.0 ± 1.0 years, 37 hard events occurred, including CD in 15 (3%) and MI in 22 (5%) patients. In a risk-adjusted multivariable Cox model, a history of prior MI, diabetes, abnormal MPS, moderate-to-severe ischemia, and post-stress EF <35% were important predictors of cardiac events. Four-year risk-adjusted survival was 97.9% for normal MPS, 87.3% for abnormal MPS with ischemia, and 82.1% for moderate-to-severe ischemia. CONCLUSIONS Among patients with previous coronary revascularization, stress-gated 99mTc-sestamibi MPS provides prognostic information for the prediction of cardiac events. A normal perfusion scan confers an excellent prognosis and an exceedingly low hard event rate (<1%/year). The presence of moderate-to-severe ischemia or a post-stress EF <35% identifies patients at highest risk of subsequent cardiac events.
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Affiliation(s)
- Tiziano Schepis
- Clinic of Cardiology, Department of Internal Medicine, City Hospital Triemli, Zurich, Switzerland
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11
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Myocardial perfusion imaging after coronary revascularization: a clinical appraisal. Eur J Nucl Med Mol Imaging 2013; 40:1275-82. [PMID: 23604804 DOI: 10.1007/s00259-013-2417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/26/2013] [Indexed: 01/09/2023]
Abstract
Revascularization procedures, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), are performed in many patients with coronary artery disease. Despite the effectiveness of these procedures, different follow-up strategies need to be considered for the management of patients after revascularization. Stress myocardial perfusion single-photon emission computed tomography (MPS) is a suitable imaging method for the evaluation of patients who have undergone PCI or CABG, and it has been used in the follow-up of such patients. Radionuclide imaging is included in the follow-up strategies after PCI and CABG in patients with symptoms, but guidelines warn against routine testing of all asymptomatic patients after revascularization. After PCI, in the absence of symptoms, radionuclide imaging is recommended and indicated as appropriate after incomplete or suboptimal revascularization and in specific asymptomatic patient subsets. On the other hand, the value of MPS late after CABG in risk stratification has been demonstrated even in the absence of symptoms. Thus, given the adverse outcome associated with silent ischaemia, it can be speculated that all patients regardless of clinical status should undergo stress testing late after revascularization. Larger prospective studies are needed to assess whether stress MPS will have an impact on the outcome in asymptomatic patients after revascularization.
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12
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Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function. Eur J Nucl Med Mol Imaging 2012; 40:315-24. [PMID: 23224706 DOI: 10.1007/s00259-012-2302-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/07/2012] [Indexed: 12/18/2022]
Abstract
PURPOSE Exercise training might exert its beneficial effects on myocardial perfusion by inducing coronary vascular adaptations or enhancing collateralization. We evaluated whether long-term exercise-based cardiac rehabilitation started early after ST-elevation acute myocardial infarction (STEMI) improves myocardial perfusion and left ventricular (LV) function. METHODS Forty-six patients with recent STEMI and residual inducible hypoperfusion were randomized into two groups: 25 enrolled in a 6-month outpatient exercise-based cardiac rehabilitation programme (group T) and 21 discharged with generic instructions for maintaining physical activity and correct lifestyle (group C). All patients underwent cardiopulmonary exercise test and dipyridamole rest gated myocardial perfusion single photon emission computed tomography within 1 week after STEMI and at 6-month follow-up. RESULTS At follow-up, group T showed an improvement in peak oxygen consumption, oxygen pulse and in the slope of increase in ventilation over carbon dioxide output (all p < 0.01) associated with a reduction of stress-induced hypoperfusion (p < 0.01) and an improvement in resting and post-stress wall motion score indexes (both p < 0.01), resting and post-stress wall thickening score indexes (both p < 0.05) and resting and post-stress LV ejection fraction (both p < 0.05). On the contrary, no changes in cardiopulmonary indexes, myocardial perfusion and LV function parameters were observed in group C at follow-up. CONCLUSION Exercise training started early after STEMI reduces stress-induced hypoperfusion and improves LV function and contractility. Exercise-induced changes in myocardial perfusion and function were associated with the absence of unfavourable LV remodelling and with an improvement of cardiovascular functional capacity.
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Guenancia C, Cochet A, Humbert O, Dygai-Cochet I, Lorgis L, Zeller M, Stamboul K, Brunotte F, Cottin Y. Predictors of post-stress LVEF drop 6 months after reperfused myocardial infarction: a gated myocardial perfusion SPECT study. Ann Nucl Med 2012; 27:112-22. [PMID: 23065422 DOI: 10.1007/s12149-012-0661-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/02/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify the predictive factors of myocardial stunning as assessed by the drop in post-stress Left Ventricular Ejection Fraction (LVEF) in patients with a recent history of myocardial infarction (MI). METHODS We prospectively included 215 consecutive patients admitted for acute MI who underwent percutaneous coronary intervention with a greater than or equal to grade-3 TIMI flow in the culprit vessel. Six months after discharge, a post-stress/rest 99mTc-sestamibi gated SPECT was performed. The perfusion score was evaluated visually using a 17-segment model. The LVEF drop was considered significant if the post-stress LVEF was ≥ 5% below the rest LVEF (QGS® software). RESULTS A post-stress LVEF drop was observed in 51 (24%) patients. Patients with an LVEF drop were more likely than patients with a stable post-stress LVEF to have diabetes (22% vs. 10%, p = 0.048), significant ischemia (SDS > 2) (51% vs. 28% p = 0.003) and higher rest LVEF [62% (56-69) vs. 56% (49-63) p < 0.001]. In contrast, summed rest score, related to infarct size, did not differ between the groups. Multivariate logistic regression analysis identified SDS > 2 (OR 3.78, 95% CI 1.8-7.92, p < 0.001), diabetes (OR 3.35, 95% CI 1.33-8.49; p = 0.011) and rest LVEF (OR 1.08, 95% CI 1.04-1.12, p < 0.001) as independent explanatory variables of an LVEF drop. CONCLUSION In patients with recent MI and post-procedural grade-3 TIMI flow, ischemia and diabetes were independent predictive factors of myocardial stunning. The higher incidence of reversible perfusion abnormalities validates the model of myocardial stunning in the post-MI period, and excludes the potential involvement of myocardial necrosis.
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Affiliation(s)
- C Guenancia
- Cardiology Department, CHU Dijon, 14 rue P. Gaffarel, 21000, Dijon, France.
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Azemi T, Rai M, Parwani P, Baghdasarian S, Kazi F, Ahlberg AW, Cyr G, Katten D, O'Sullivan D, Fram D, Heller GV. Electrocardiographic changes during vasodilator SPECT myocardial perfusion imaging: does it affect diagnosis or prognosis? J Nucl Cardiol 2012; 19:84-91. [PMID: 21947978 DOI: 10.1007/s12350-011-9457-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Significance of electrocardiographic (ECG) changes during vasodilator stress myocardial perfusion imaging (MPI) is controversial. We examined the diagnostic and prognostic significance of ECG changes during vasodilator single photon emission computerized tomography (SPECT) MPI. METHODS We studied consecutive patients who underwent vasodilator SPECT MPI from 1995 to 2009. Patients with baseline ECG abnormalities, previous history of coronary artery bypass graft surgery or myocardial infarction (MI) were excluded. Significant coronary artery disease (CAD) was defined as >70% stenosis of any vessel or ≥50% stenosis of left main. Mean follow-up was 2.4 ± 1.5 years for cardiac events (cardiac death and non-fatal MI). RESULTS Of patients in the diagnostic cohort, ST depression was associated with increased incidence of CAD with abnormal (P = .020 and P <.001) but not in those with normal perfusion (P = .342). Of 3,566 patients with follow-up in the prognostic cohort, including 130 (5.0%) with ST depression and normal perfusion, the presence of ST depression ≥1 mm did not affect the outcomes in any summed stress score category. CONCLUSIONS ST depression ≥1 mm during vasodilator SPECT MPI is associated with CAD in patients with abnormal perfusion, but provides no additional risk stratification beyond concomitant perfusion imaging, including those with normal studies.
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Affiliation(s)
- Talhat Azemi
- Nuclear Cardiology Laboratory, Henry Low Heart Center, Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Georgoulias P, Valotassiou V, Tsougos I, Demakopoulos N. Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention. Curr Cardiol Rev 2011; 6:98-103. [PMID: 21532775 PMCID: PMC2892082 DOI: 10.2174/157340310791162677] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 01/06/2010] [Accepted: 02/25/2010] [Indexed: 11/22/2022] Open
Abstract
Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients’ risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients’ long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI. Although there are enough published data demonstrating the value of myocardial perfusion SPECT imaging in patients after PCI, there is still debate on whether or not these tests should be performed routinely.
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Acampa W, Di Taranto MD, Morgante A, Salvatore B, Evangelista L, Ricci F, Costanzo P, de Sisto E, Filardi PP, Petretta M, Fortunato G, Cuocolo A. C-reactive protein levels are associated with paraoxonase polymorphism L55M in patients undergoing cardiac SPECT imaging. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 71:179-84. [DOI: 10.3109/00365513.2010.548529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Incremental prognostic value of 99mTc-tetrofosmin myocardial SPECT after percutaneous coronary intervention. Ann Nucl Med 2009; 22:899-909. [DOI: 10.1007/s12149-008-0191-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 07/09/2008] [Indexed: 11/26/2022]
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Long-Term Prognostic Value of Tc-99m Tetrofosmin Myocardial Gated-SPECT Imaging in Asymptomatic Patients After Percutaneous Coronary Intervention. Clin Nucl Med 2008; 33:743-7. [DOI: 10.1097/rlu.0b013e318187ee88] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Acampa W, Petretta M, Evangelista L, Nappi G, Luongo L, Petretta MP, Cuocolo A. Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events. J Thorac Cardiovasc Surg 2008; 136:46-51. [PMID: 18603052 DOI: 10.1016/j.jtcvs.2007.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 09/10/2007] [Accepted: 10/04/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We assessed predictors and temporal characteristics of cardiac risk in patients undergoing stress single-photon emission computed tomography after coronary artery bypass grafting. METHODS Stress cardiac tomography was performed in 362 patients 5 years after coronary artery bypass grafting. Cardiac death and myocardial infarction were considered as events. Cox proportional hazards analysis was used to identify predictors of events and parametric survival analysis to predict time to events. RESULTS During a median follow-up of 27 months, 22 cardiac events occurred (6.1% cumulative event rate). At multivariable Cox analysis, ischemia at cardiac tomography (hazards ratio 3.7, 95% confidence interval 1.5-9.1; P = .004), and diabetes (hazards ratio 3.6, 95% confidence interval 1.5-8.5; P = .006) resulted in independent predictors of events. Event-free survival was 96% in patients with normal cardiac tomography, 86% in those with abnormal tomography without ischemia, and 70% in those with (log-rank 10.6, P for trend = .008). The parametric survival model revealed that the cardiac risk was greater for all time intervals and accelerated more over time in patients with ischemia than in those without (chi(2) 21.4, P < .0001). Patients without diabetes and normal cardiac tomography remained below a defined risk level (5%) for the entire follow-up period. CONCLUSION Stress cardiac tomography performed 5 years after coronary artery bypass grafting is useful to characterize the risk of cardiac events and its temporal variation. Parametric survival model estimates the predicted time to risk and the level of risk at specific time intervals after coronary artery bypass grafting.
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Affiliation(s)
- Wanda Acampa
- Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy
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Acampa W, Evangelista L, Petretta M, Liuzzi R, Cuocolo A. Usefulness of stress cardiac single-photon emission computed tomographic imaging late after percutaneous coronary intervention for assessing cardiac events and time to such events. Am J Cardiol 2007; 100:436-41. [PMID: 17659924 DOI: 10.1016/j.amjcard.2007.03.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 03/06/2007] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
This study assessed the predictors and temporal characteristics of cardiac risk in patients undergoing stress single-photon emission computed tomography (SPECT) after percutaneous coronary intervention (PCI). Stress SPECT was performed in 346 patients 12 to 18 months after PCI. Cardiac death and myocardial infarction were considered events. Cox proportional hazards analysis was used to identify predictors of events and parametric survival analysis to predict time to events. During follow-up (31 +/- 10 months), 17 events occurred (4.9% cumulative event rate). Prescan likelihood of ischemia and ischemia at SPECT were independent predictors of events (p <0.001). Cumulative probabilities of event-free survival were 88% in patients with ischemia at SPECT and 98% in those without (p <0.001). Patients without ischemia at SPECT were at low probability of failure and times to achieve > or =2% risk of events were >48 months in those with low prescan likelihood of ischemia and >20 months in those with intermediate to high prescan likelihood. Ischemia at SPECT was associated with higher probability of failure accelerating over time. In conclusion, clinical variables and stress SPECT performed 12 to 18 months after PCI are useful to characterize risk of cardiac events and its temporal variation. Parametric survival models seem useful to estimate predicted time to risk and levels of risk at specific intervals after PCI.
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Affiliation(s)
- Wanda Acampa
- Institute of Biostructures and Bioimages, National Council of Research, Naples, Italy
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Solodky A, Assali AR, Mats I, Ben-Gal T, Kornowski R, Battler A, Zafrir N. Prognostic Value of Myocardial Perfusion Imaging in Symptomatic and Asymptomatic Patients after Percutaneous Coronary Intervention. Cardiology 2006; 107:38-43. [PMID: 16741356 DOI: 10.1159/000093611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 04/04/2006] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the value of myocardial perfusion imaging (MPI) in predicting major adverse cardiovascular events (MACE) in symptomatic and asymptomatic patients after percutaneous coronary intervention (PCI). We revised retrospectively patients after PCI that underwent MPI and were followed for a year for the presence of MACE. We found no differences in the incidence of MACE between symptomatic and asymptomatic patients. On multivariate analysis, the presence of ischemia by MPI was the most important independent predictor of MACE (OR 5.09, CI 95% 2.15-12.05, p < 0.001). The presence of myocardial ischemia by MPI performed after PCI, and no symptom status, predicts a worse outcome during 1 year of follow-up.
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Affiliation(s)
- Alejandro Solodky
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Rajagopal V, Gurm HS, Brunken RC, Pothier CE, Bhatt DL, Lauer MS. Prediction of death or myocardial infarction by exercise single photon emission computed tomography perfusion scintigraphy in patients who have had recent coronary artery stenting. Am Heart J 2005; 149:534-40. [PMID: 15864244 DOI: 10.1016/j.ahj.2004.08.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although practice guidelines do not recommend routine exercise testing of patients after coronary stenting, several small studies have suggested that stress myocardial perfusion imaging can provide prognostic information about future adverse cardiac events. We sought to determine if exercise nuclear testing provides independent prognostic information in patients after coronary stenting. METHODS We analyzed the outcomes of 370 patients who underwent dual isotope exercise nuclear scintigraphy at least 1 month after coronary stenting and had testing between April 1996 and May 2002. Patients were classified according to presence or absence of any ischemia. The primary endpoint was all-cause mortality or myocardial infarction (MI) during a median of 30 months (range 6-59) of follow-up. RESULTS There were 86 patients (23%) who had ischemia. Major events--death or MI--occurred in 62 patients including 22 deaths. Among patients with no ischemia, the 30-month event rate was 9.1%, whereas among patients with ischemia, the event rate was 17.0% (P = .001). After adjusting for age, sex, standard cardiac risk factors, cardiac history, left ventricular ejection fraction, angiographic findings, procedural variables, exercise capacity, and heart-rate dynamics, the presence of scintigraphic evidence of ischemia predicted death or MI (adjusted hazard ratio 2.08, 95% CI 1.21-3.56, P = .008). The presence of ischemia similarly predicted events in asymptomatic patients (adjusted hazard ratio 2.19, 95% CI 1.17-4.11, P = .015). CONCLUSIONS In patients with recent coronary stent placement, reversible nuclear perfusion defects independently predicted risk of death or MI.
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Affiliation(s)
- Vivek Rajagopal
- Department of Cardiovascular, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Petretta M, Storto G, Acampa W, Sansone V, Evangelista L, Spinelli L, Cuocolo A. Relation between wall thickening on gated perfusion SPECT and functional recovery after coronary revascularization in patients with previous myocardial infarction. Eur J Nucl Med Mol Imaging 2004; 31:1599-605. [PMID: 15290115 DOI: 10.1007/s00259-004-1613-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to evaluate whether wall thickening analysis by gated perfusion single-photon emission computed tomography (SPECT) is useful in predicting functional recovery after revascularization. METHODS Forty-one patients with previous myocardial infarction and left ventricular (LV) dysfunction (ejection fraction, EF, 36+/-6%) who were scheduled for revascularization underwent rest 99mTc-sestamibi gated SPECT. RESULTS Of 131 akinetic or dyskinetic segments at baseline echocardiography, 82 (63%) recovered after revascularization. Compared with wall thickening analysis, perfusion imaging provided higher sensitivity (78% vs 50%, P<0.0001) and specificity (80% vs 71%, P<0.0005). Among segments with > or =55% sestamibi uptake (viable), those with detectable wall thickening had a higher likelihood of functional recovery than those with absent wall thickening (95% vs 77%, P<0.05). In segments with improved function, the absence of wall thickening was associated with lower sestamibi activity than was observed when detectable wall thickening was present (58+/-14% vs 71+/-13%, P<0.0005). An increase in EF of > or =5% was detectable in 22 (54%) patients. For the prediction of EF improvement, perfusion imaging provided a higher sensitivity than wall thickening analysis (68% vs 41%, P<0.05), while specificity was not significantly different (68% vs 74%). The prevalence of patients with functional recovery did not change when wall thickening analysis was considered in addition to perfusion status (73% in patients with detectable wall thickening and 70% in those without; P=NS). CONCLUSION In patients with coronary artery disease, wall thickening analysis by gated perfusion SPECT provides additional information compared with perfusion data for the prediction of segmental functional recovery. However, on a patient basis, wall thickening assessment seems to be of more limited value than perfusion status.
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Affiliation(s)
- Mario Petretta
- Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy
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Affiliation(s)
- Leslee J Shaw
- Atlanta Cardiovascular Research Institute, Atlanta, GA 30342, USA.
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