Stress first myocardial perfusion imaging: Is it time to put to rest the “Rest First” strategy for most patients?
While myocardial perfusion imaging (MPI) remains the most validated and extensively utilized modality in the evaluation and prognostication of coronary artery disease (CAD), it has come under unprecedented scrutiny in the past few years both due to the expansive growth of cardiac imaging1 and increasing concerns of patient radiation exposure over their lifetime. In one study, nuclear cardiac imaging was reported to be contributing up to 22% of radiation exposure amongst all imaging.2
Over the past few years, major cardiac societies such as the American College of Cardiology/American Heart Association in collaboration with many other imaging societies have taken proactive steps to guide the use of cardiac imaging. Appropriate use criteria for nuclear cardiology, echocardiography, CT/MRI, and most recently, cardiac catheterization and percutaneous coronary interventions have been published to ensure that clinicians in most instances are “doing the right test for the right patient at the r
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- Depuey EG, Mahmarian JJ, Miller TD, Einstein AJ, et al. Patient centered imaging. J Nucl Cardiol 2012;19:185-215. CrossRef
- Chang SM, Nabi F, Xu J, Raza U, et al. Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. J Am Coll Cardiol 2010;55:221-30. CrossRef
- Duvall WL, Wijetunga MN, Klein TM, Razzouk L, et al. The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study. J Nucl Cardiol 2010;17:370-7. CrossRef
- Hachamovitch R, Berman DS, Shaw LJ, Kiat H, 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;98(2):190.
- Singh B, Bateman TM, Case JA, Heller G. Attenuation artifact, attenuation correction, and the future of myocardial perfusion SPECT. J Nucl Cardiol 2007;14:153-64. CrossRef
- Heller GV, Bateman TM, Johnson LL, Cullom SJ, et al. Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol 2004;11:273-81. CrossRef
- Gemignani AS, Muhlebach SG, Abbott BG, Roye GD, et al. Stress-only or stress/rest myocardial perfusion imaging in patients undergoing evaluation for bariatric surgery. J Nucl Cardiol 2011;18:886-92. CrossRef
- Gibson PB, Demus D, Noto R, Hudson W, et al. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. J Am Coll Cardiol 2002;39:999-1004. CrossRef
- Duvall WL, Hiensch RJ, Levine EJ, Croft LB, et al. The prognosis of a normal Tl-201 stress-only SPECT MPI study. J Nucl Cardiol 2012; doi:10.1007/s12350-012-9601-2.
- Bateman TM, Heller GV, McGhie AI, Courter SA, et al. Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging. J Nucl Cardiol 2009;16:726-35. CrossRef
- Depuey EG, Ata P, Wray R, Friedman M. Very low-activity stress/high-activity rest, single-day myocardial perfusion SPECT with a conventional sodium iodide camera and wide beam reconstruction processing. J Nucl Cardiol 2012; doi:10.1007/s12350-012-9596-8.
- Duvall WL, Baber U, Elliot L, Croft L, et al. A model for successful prediction of stress-first Tc-99m MPI. J Nucl Cardiol 2012; doi:10.1007/s12350-012-9606-x.
- Stress first myocardial perfusion imaging: Is it time to put to rest the “Rest First” strategy for most patients?
Journal of Nuclear Cardiology
Volume 19, Issue 6 , pp 1106-1109
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- 1. Heart and Vascular Institute, Henry Ford Hospital, K-14, Detroit, MI, 48202, USA