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Does Myocardial Perfusion Imaging Provide Incremental Prognostic Information to Left Ventricular Ejection Fraction?

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Abstract

Cardiac nuclear imaging studies such as gated single photon emission computed tomography can offer assessment of myocardial perfusion and ventricular function. These two types of data can provide valuable information for the diagnosis of coronary artery disease, prognosis, and optimal treatment strategies. Ejection fraction and other measures of ventricular function generally are the best predictors of mortality, whereas perfusion parameters and estimates of ischemic burden are often the best predictors of nonfatal cardiac events and response to revascularization; the combination of both can provide increased sensitivity and specificity for diagnosis of significant coronary disease, and increased predictive power for outcomes. Recent data show that together they also add incremental value in predicting sudden cardiac death. Less commonly used modalities such as positron emission tomography may offer additional tools for quantification of perfusion and function at rest and at stress, with important clinical implications.

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Abbreviations

COURAGE:

Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation

HF-ACTION:

Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training

J-ACCESS:

Prognostic Study of Risk Stratification Among Japanese Patients With Ischemic Heart Disease Using Gated Myocardial Perfusion SPECT

MADIT-II:

Multicenter Automatic Defibrillator Implantation Trial II

References

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  1. Borer JS, Bacharach SL, Green MV, et al.: Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. N Engl J Med 1977, 296:839–844.

    CAS  PubMed  Google Scholar 

  2. Zaret BL, Strauss HW, Martin ND, et al.: Noninvasive regional myocardial perfusion with radioactive potassium. Study of patients at rest, with exercise and during angina pectoris. N Engl J Med 1973, 288:809–812.

    Article  CAS  PubMed  Google Scholar 

  3. Narahara KA, Mena I, Maublant JC, et al.: Simultaneous maximal exercise radionuclide angiography and thallium stress perfusion imaging. Am J Cardiol 1984, 53:812–817.

    Article  CAS  PubMed  Google Scholar 

  4. Cwajg E, Cwajg J, He ZX, et al.: Gated myocardial perfusion tomography for the assessment of left ventricular function and volumes: comparison with echocardiography. J Nucl Med 1999, 40:1857–1865.

    CAS  PubMed  Google Scholar 

  5. Schaefer WM, Lipke CS, Standke D, et al.: Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT. J Nucl Med 2005, 46:1256–1263.

    PubMed  Google Scholar 

  6. Johnson SH, Bigelow C, Lee KL, et al.: Prediction of death and myocardial infarction by radionuclide angiocardiography in patients with suspected coronary artery disease. Am J Cardiol 1991, 67:919–926.

    Article  CAS  PubMed  Google Scholar 

  7. Austin EH, Cobb FR, Coleman RE, Jones RH: Prospective evaluation of radionuclide angiocardiography for the diagnosis of coronary artery disease. Am J Cardiol 1982, 50:1212–1216.

    Article  CAS  PubMed  Google Scholar 

  8. Sharir T, Bacher-Stier C, Dhar S, et al.: Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99 m sestamibi gated single-photon emission computed tomography. Am J Cardiol 2000, 86:1171–1175.

    Article  CAS  PubMed  Google Scholar 

  9. Hachamovitch R, Berman DS, Kiat H, et al.: Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996, 93:905–914.

    CAS  PubMed  Google Scholar 

  10. Iskandrian AS, Chae SC, Heo J, et al.: Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993, 22:665–670.

    Article  CAS  PubMed  Google Scholar 

  11. Palmas W, Friedman JD, Diamond GA, et al.: Incremental value of simultaneous assessment of myocardial function and perfusion with technetium-99 m sestamibi for prediction of extent of coronary artery disease. J Am Coll Cardiol 1995, 25:1024–1031.

    Article  CAS  PubMed  Google Scholar 

  12. Borges-Neto S, Shaw LJ, Kesler KL, et al.: Prediction of severe coronary artery disease by combined rest and exercise radionuclide angiocardiography and tomographic perfusion imaging with technetium 99 m-labeled sestamibi: a comparison with clinical and electrocardiographic data. J Nucl Cardiol 1997, 4:189–194.

    Article  CAS  PubMed  Google Scholar 

  13. Yamagishi H, Shirai N, Yoshiyama M, et al.: Incremental value of left ventricular ejection fraction for detection of multivessel coronary artery disease in exercise (201)Tl gated myocardial perfusion imaging. J Nucl Med 2002, 43:131–139.

    PubMed  Google Scholar 

  14. Johnson LL, Verdesca SA, Aude WY, et al.: Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997, 30:1641–1648.

    Article  CAS  PubMed  Google Scholar 

  15. Lee KL, Pryor DB, Pieper KS, et al.: Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables. Circulation 1990, 82:1705–1717.

    CAS  PubMed  Google Scholar 

  16. Ward RP, Gundeck EL, Lang RM, et al.: Overestimation of postischemic myocardial stunning on gated SPECT imaging: correlation with echocardiography. J Nucl Cardiol 2006, 13:514–520.

    Article  PubMed  Google Scholar 

  17. Borges-Neto S, Shaw LJ, Kesler K, et al.: Usefulness of serial radionuclide angiography in predicting cardiac death after coronary artery bypass grafting and comparison with clinical and cardiac catheterization data. Am J Cardiol 1997, 79:851–855.

    Article  CAS  PubMed  Google Scholar 

  18. Jones RH, Johnson SH, Bigelow C, et al.: Exercise radionuclide angiocardiography predicts cardiac death in patients with coronary artery disease. Circulation 1991, 84:I52–I58.

    CAS  PubMed  Google Scholar 

  19. Borges-Neto S, Shaw LK, Tuttle RH, et al.: Incremental prognostic power of single-photon emission computed tomographic myocardial perfusion imaging in patients with known or suspected coronary artery disease. Am J Cardiol 2005, 95:182–188.

    Article  PubMed  Google Scholar 

  20. Marie PY, Danchin N, Durand JF, et al.: Long-term prediction of major ischemic events by exercise thallium-201 single-photon emission computed tomography. Incremental prognostic value compared with clinical, exercise testing, catheterization and radionuclide angiographic data. J Am Coll Cardiol 1995, 26:879–886.

    Article  CAS  PubMed  Google Scholar 

  21. Hachamovitch R, Berman DS, Shaw LJ, et al.: Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998, 97:535–543.

    CAS  PubMed  Google Scholar 

  22. Nallamouthu N, Araujo L, Russell J, et al.: Prognostic value of simultaneous perfusion and function assessment using technetium-99 m sestamibi. Am J Cardiol 1996, 78:562–564.

    Article  CAS  PubMed  Google Scholar 

  23. Sharir T, Germano G, Kavanagh PB, et al.: Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 1999, 100:1035–1042.

    CAS  PubMed  Google Scholar 

  24. Sharir T, Germano G, Kang X, et al.: Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001, 42:831–837.

    CAS  PubMed  Google Scholar 

  25. Bourque JM, Velazquez EJ, Tuttle RH, et al.: Mortality risk associated with ejection fraction differs across resting nuclear perfusion findings. J Nucl Cardiol 2007, 14:165–173.

    Article  PubMed  Google Scholar 

  26. Liao L, Smith WT 4th, Tuttle RH, et al.: Prediction of death and nonfatal myocardial infarction in high-risk patients: a comparison between the Duke treadmill score, peak exercise radionuclide angiography, and SPECT perfusion imaging. J Nucl Med 2005, 46:5–11.

    PubMed  Google Scholar 

  27. Travin MI, Heller GV, Johnson LL, et al.: The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99 m sestamibi myocardial perfusion imaging. J Nucl Cardiol 2004, 11:253–262.

    Article  PubMed  Google Scholar 

  28. Petix NR, Sestini S, Coppola A, et al.: Prognostic value of combined perfusion and function by stress technetium-99 m sestamibi gated SPECT myocardial perfusion imaging in patients with suspected or known coronary artery disease. Am J Cardiol 2005, 95:1351–1357.

    Article  PubMed  Google Scholar 

  29. Gimelli A, Rossi G, Landi P, et al.: Stress/rest myocardial perfusion abnormalities by gated SPECT: still the best predictor of cardiac events in stable ischemic heart disease. J Nucl Med 2009, 50:546–553.

    Article  PubMed  Google Scholar 

  30. Matsumoto N, Sato Y, Suzuki Y, et al.: Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J 2008, 72:2035–2039.

    Article  PubMed  Google Scholar 

  31. Nakajima K, Kusuoka H, Nishimura S, et al.: 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, 23:373–381.

    Article  PubMed  Google Scholar 

  32. Shaw LJ, Hendel RC, Cerquiera M, et al.: Ethnic differences in the prognostic value of stress technetium-99 m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005, 45:1494–1504.

    Article  PubMed  Google Scholar 

  33. Sharir T, Kang X, Germano G, et al.: Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes. J Nucl Cardiol 2006, 13:495–506.

    Article  PubMed  Google Scholar 

  34. Wexler O, Yoder SR, Elder JL, et al.: Effect of gender on cardiovascular risk stratification with ECG gated SPECT left ventricular volume indices and ejection fraction. J Nucl Cardiol 2009, 16:28–37.

    Article  PubMed  Google Scholar 

  35. America YG, Bax JJ, Boersma E, et al.: The additive prognostic value of perfusion and functional data assessed by quantitative gated SPECT in women. J Nucl Cardiol 2009, 16:10–19.

    Article  PubMed  Google Scholar 

  36. Chandra S, Lenihan DJ, Wei W, et al.: Myocardial perfusion imaging and cardiovascular outcomes in a cancer population. Tex Heart Inst J 2009, 36:205–213.

    PubMed  Google Scholar 

  37. De Winter O, Velghe A, Van de Veire N, et al.: Incremental prognostic value of combined perfusion and function assessment during myocardial gated SPECT in patients aged 75 years or older. J Nucl Cardiol 2005, 12:662–670.

    Article  PubMed  Google Scholar 

  38. Atchley AE, Kitzman DW, Whellan DJ, et al.: Relationship of baseline gated rest SPECT myocardial perfusion imaging to death and hospitalization in heart failure patients: results from the nuclear substudy of the HF-ACTION Trial. Presented at the Heart Failure Society of America. Boston, MA; September 16–19, 2009.

  39. Yusuf S, Zucker D, Peduzzi P, et al.: Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994, 344:563–570.

    Article  CAS  PubMed  Google Scholar 

  40. Hachamovitch R, Hayes SW, Friedman JD, et al.: Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003, 107:2900–2907.

    Article  PubMed  Google Scholar 

  41. Hachamovitch R, Rozanski A, Hayes SW, et al.: Predicting therapeutic benefit from myocardial revascularization procedures: are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary? J Nucl Cardiol 2006, 13:768–778.

    Article  PubMed  Google Scholar 

  42. •• Shaw LJ, Berman DS, Maron DJ, et al.: Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008, 117:1283–1291. This is an analysis of the nuclear substudy of the COURAGE trial. This paper provides important information about the role of ischemia in the evaluation and modulation of risk for patients with stable CAD.

    Article  PubMed  Google Scholar 

  43. Buxton AE, Lee KL, Hafley GE, et al.: Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol 2007, 50:1150–1157. This article delineates the significant limitations in the current EF-based system of risk stratification for SCD.

    Article  PubMed  Google Scholar 

  44. Piccini JP, Horton JR, Shaw LK, et al.: Single-photon emission computed tomography myocardial perfusion defects are associated with an increased risk of all-cause death, cardiovascular death, and sudden cardiac death. Circ Cardiovasc Imaging 2008, 1:180–188. This is an important study demonstrating the usefulness of SPECT in improving risk assessment for SCD.

    Article  PubMed  Google Scholar 

  45. Morishima I, Sone T, Tsuboi H, et al.: Risk stratification of patients with prior myocardial infarction and advanced left ventricular dysfunction by gated myocardial perfusion SPECT imaging. J Nucl Cardiol 2008, 15:631–637.

    Article  PubMed  Google Scholar 

  46. •• Jacobson AF: ADMIRE-HF: Prognostic significance of 123I-mIBG myocardial scintigraphy in heart failure patients [abstract #416]. Presented at the American College of Cardiology 58th Annual Scientific Session. Orlando, FL; March 29–31, 2009. This is the first report of a prospective evaluation of123I-mIBG in predicting heart failure progression, arrhythmic events, and cardiac death in patients with heart failure.

  47. Dorbala S, Vangala D, Sampson U, et al.: Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: a 82Rb PET/CT study. J Nucl Med 2007, 48:349–358.

    PubMed  Google Scholar 

  48. Dorbala S, Hachamovitch R, Curillova Z, et al.: Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging 2009, 2:846–854.

    Article  PubMed  Google Scholar 

  49. Tio RA, Dabeshlim A, Siebelink HM, et al.: Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients with ischemic heart disease. J Nucl Med 2009, 50:214–219.

    Article  PubMed  Google Scholar 

  50. Kobayashi Y, Lardo AC, Nakajima Y, et al.: Left ventricular function, myocardial perfusion and viability. Cardiol Clin 2009, 27:645–654.

    Article  PubMed  Google Scholar 

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Correspondence to Salvador Borges-Neto.

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Mudrick, D.W., Velazquez, E. & Borges-Neto, S. Does Myocardial Perfusion Imaging Provide Incremental Prognostic Information to Left Ventricular Ejection Fraction?. Curr Cardiol Rep 12, 155–161 (2010). https://doi.org/10.1007/s11886-010-0093-x

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