Current Cardiology Reports

, 16:472

Assessing the Prognostic Implications of Myocardial Perfusion Studies: Identification of Patients at Risk vs Patients who May Benefit from Intervention?

Authors

  • Paul Cremer
    • Section of Cardiovascular Imaging, Department of Cardiovascular MedicineHeart and Vascular Institute, Cleveland Clinic
    • Section of Cardiovascular Imaging, Department of Cardiovascular MedicineHeart and Vascular Institute, Cleveland Clinic
Nuclear Cardiology (V Dilsizian, Section Editor)

DOI: 10.1007/s11886-014-0472-9

Cite this article as:
Cremer, P. & Hachamovitch, R. Curr Cardiol Rep (2014) 16: 472. doi:10.1007/s11886-014-0472-9
Part of the following topical collections:
  1. Topical Collection on Nuclear Cardiology

Abstract

Stress myocardial perfusion imaging (MPI) has a well-established role in improving risk stratification. Recent analyses, compared with older data, suggest that the yield of stress MPI has decreased. In part, this trend relates to testing patients with heterogeneous, but improved, risk factor modification. In this setting, positron emission tomography with myocardial flow reserve enhances risk stratification as it reflects the end result of atherosclerosis. Recent studies have also emphasized the clinical impact of incremental risk stratification by assessing net reclassification improvement (NRI). Previous retrospective studies have favored an ischemic threshold to select patients that benefit from revascularization, but this finding has not been corroborated in randomized trials. However, no large randomized trial has directly tested a strategy of revascularization for patients with at least a moderate amount of ischemia at risk. Unfortunately, even when faced with a significantly abnormal MPI result, subsequent action is too often absent.

Keywords

Coronary artery diseaseDiabetes mellitusEarly revascularizationMyocardial perfusion imagingSingle photon emission computed tomographyPositron emission tomographyNet reclassification improvementMyocardial flow reserve

Copyright information

© Springer Science+Business Media New York 2014