Current Cardiology Reports

, 16:465

Assessing Clinical Impact of Myocardial Perfusion Studies: Ischemia or Other Prognostic Indicators?

Authors

    • Division of Cardiovascular Diseases and the Department of Internal MedicineMayo Clinic
    • Mayo Clinic
  • John Wells Askew
    • Division of Cardiovascular Diseases and the Department of Internal MedicineMayo Clinic
  • Joerg Herrmann
    • Division of Cardiovascular Diseases and the Department of Internal MedicineMayo Clinic
Nuclear Cardiology (V Dilsizian, Section Editor)

DOI: 10.1007/s11886-014-0465-8

Cite this article as:
Miller, T.D., Askew, J.W. & Herrmann, J. Curr Cardiol Rep (2014) 16: 465. doi:10.1007/s11886-014-0465-8
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Part of the following topical collections:
  1. Topical Collection on Nuclear Cardiology

Abstract

One of the major strengths of nuclear myocardial perfusion imaging (MPI) is the robust prognostic databases from observational studies demonstrating significantly different outcomes in patients with low-risk vs high-risk scans. The severity of the MPI defect can be semi-quantitated using the summed stress score (SSS) and summed difference score (SDS). SSS is more strongly associated with mortality, whereas SDS is the better predictor of subsequent coronary angiography and revascularization. The strength of MPI variables as prognostic indicators decreases when adjusted for prognostically important clinical and stress test variables. Nonetheless, most studies of general patient populations have demonstrated that MPI adds incremental prognostic value to clinical and stress test information. In contrast to these positive results from observational studies, the application of MPI ischemia as a treatment guide in several recent trials (DIAD, WOMEN, COURAGE, BARI 2D, STICH) has largely failed to identify patient subsets with improved outcome. This issue will continue to be investigated in the ongoing PROMISE and ISCHEMIA trials.

Keywords

SPECT (single photon emission computed tomography)MPI (myocardial perfusion imaging)Summed stress scoreSummed difference scoreIschemiaPrognosisCoronary artery disease

Copyright information

© Springer Science+Business Media New York 2014