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Doyle M, Weinberg N, Pohost GM, Bairey Merz CN, Shaw LJ, Sopko G, Fuisz A, Rogers WJ, Walsh EG, Johnson BD, Sharaf BL, Pepine CJ, Mankad S, Reis SE, Rayarao G, Vido DA, Bittner V, Tauxe L, Olson MB, Kelsey SF, Biederman RWW. Left Ventricular Energy Model Predicts Adverse Events in Women With Suspected Myocardial Ischemia: Results From The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study. Cardiovasc Diagn Ther 2013; 3:64-72. [PMID: 24015377 PMCID: PMC3763744 DOI: 10.3978/j.issn.2223-3652.2013.05.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/06/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To assess the prognostic value of a left ventricular energy-model in women with suspected myocardial ischemia. BACKGROUND The prognostic value of internal energy utilization (IEU) of the left ventricle in women with suspected myocardial ischemia is unknown. METHODS Women (n=227, mean age 59±12 years, range 31-86), with symptoms of myocardial ischemia, underwent myocardial perfusion imaging (MPI) assessment for regional perfusion defects along with measurement of ventricular volumes separately by gated Single Photon Emission Computed Tomography (SPECT) (n= 207) and magnetic resonance imaging (MRI) (n=203). During follow-up (40±17 months), time to first major adverse cardiovascular event (MACE, death, myocardial infarction or hospitalization for congestive heart failure) was analyzed using MRI and gated SPECT variables. RESULTS Adverse events occurred in 31 (14%). Multivariable Cox models were formed for each modality: IEU and wall thickness by MRI (Chi-squared 34, p<0.005) and IEU and systolic blood pressure by gated SEPCT (Chi-squared 34, p<0.005). The models remained predictive after adjustment for age, disease history and Framingham risk score. For each Cox model, patients were categorized as high-risk if the model hazard was positive and not high-risk otherwise. Kaplan-Meier analysis of time to MACE was performed for high-risk vs. not high-risk for MR (log rank 25.3, p<0.001) and gated SEPCT (log rank 18.2, p<001) models. CONCLUSIONS Among women with suspected myocardial ischemia a high internal energy utilization has higher prognostic value than either a low EF or the presence of a myocardial perfusion defect assessed using two independent modalities of MR or gated SPECT.
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Affiliation(s)
- Mark Doyle
- Allegheny General Hospital, Pittsburgh, PA, USA
| | - Nicole Weinberg
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Gerald M. Pohost
- Keck Medical Center, University of Southern California, Los Angeles, CA, USA
| | | | - Leslee J. Shaw
- Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - George Sopko
- National Heart Lung and Blood Institute, NIH, USA
| | - Anthon Fuisz
- Department of Medicine University of Washington, Washington DC, USA
| | | | | | - B. Delia Johnson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Steven E. Reis
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Vera Bittner
- The University of Alabama at Birmingham, AL, USA
| | | | - Marian B. Olson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sheryl F. Kelsey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Doyle M, Weinberg N, Pohost GM, Bairey Merz CN, Shaw LJ, Sopko G, Fuisz A, Rogers WJ, Walsh EG, Johnson BD, Sharaf BL, Pepine CJ, Mankad S, Reis SE, Vido DA, Rayarao G, Bittner V, Tauxe L, Olson MB, Kelsey SF, Biederman RWW. Prognostic value of global MR myocardial perfusion imaging in women with suspected myocardial ischemia and no obstructive coronary disease: results from the NHLBI-sponsored WISE (Women's Ischemia Syndrome Evaluation) study. JACC Cardiovasc Imaging 2010; 3:1030-6. [PMID: 20947048 PMCID: PMC3278772 DOI: 10.1016/j.jcmg.2010.07.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 07/09/2010] [Accepted: 07/13/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the prognostic value of global magnetic resonance (MR) myocardial perfusion imaging (MPI) in women with suspected myocardial ischemia and no obstructive (stenosis <50%) coronary artery disease (CAD). BACKGROUND The prognostic value of global MR-MPI in women without obstructive CAD remains unknown. METHODS Women (n = 100, mean age 57 ± 11 years, age range 31 to 76 years), with symptoms of myocardial ischemia and with no obstructive CAD, as assessed by coronary angiography, underwent MR-MPI and standard functional assessment. During follow-up (34 ± 16 months), time to first adverse event (death, myocardial infarction, or hospitalization for worsening anginal symptoms) was analyzed using global MPI and left ventricular ejection fraction (EF) data. RESULTS Adverse events occurred in 23 (23%) women. Using univariable Cox proportional hazards regression modeling, variables found to be predictive of adverse events were global MR-MPI average uptake slope (p < 0.05), the ratio of MR-MPI peak signal amplitude to uptake slope (p < 0.05), and EF (p < 0.05). Two multivariable Cox models were formed, 1 using variables that were performance site dependent: ratio of MR-MPI peak amplitude to uptake slope together with EF (chi square: 13, p < 0.005); and a model using variables that were performance site independent: MR-MPI slope and EF (chi square: 12, p < 0.005). Each of the 2 multivariable models remained predictive of adverse events after adjustment for age, disease history, and Framingham risk score. For each of the Cox models, patients were categorized as high risk if they were in the upper quartile of the model and as not high risk otherwise. Kaplan-Meier analysis of time to event was performed for high risk versus not high risk for site-dependent (log rank: 15.2, p < 0.001) and site-independent (log rank: 13.0, p < 001) models. CONCLUSIONS Among women with suspected myocardial ischemia and no obstructive CAD, MR-MPI-determined global measurements of normalized uptake slope and peak signal uptake, together with global functional assessment of EF, appear to predict prognosis.
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Affiliation(s)
- Mark Doyle
- Division of Cardiology, CV MRI Center, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212-4772, USA.
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McKeogh JR. The diagnostic role of stress echocardiography in women with coronary artery disease: evidence based review. Curr Opin Cardiol 2007; 22:429-33. [PMID: 17762544 DOI: 10.1097/01.hco.0000285297.61958.c0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
1) Coronary artery disease in women differs from men in several ways, including their response to many diagnostic tests.2) Strong comparative data on stress echocardiography for detecting coronary artery disease in women are lacking, but existing data consistently show sensitivity comparable with other high-sensitivity tests and superior specificity, increasing its diagnostic accuracy.3) Pharmacological stress echocardiography appears to provide superior specificity to exercise stress echocardiography due to difficulties in test execution with the latter that increase the number of false positive results.4) Current evidence suggests that stress echocardiography should be the first-line diagnostic tool for detecting coronary artery disease in women with chest pain, but other noninvasive imaging tests may be valuable in some patient subgroups.
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Affiliation(s)
- John R McKeogh
- Wolters Kluwer Health Adis, Auckland, New Zealand, an editorial office of Wolters Kluwer Health, Conshohocken, Pennsylvania, USA
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