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Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD).

Methods and results

We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2–4) in 180, moderate (SDS 5–7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information.

Conclusion

Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD.

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Acknowledgments

The study has been supported by CARIGE Foundation within the program: “Studio Medico Nucleare di Variabili fisiologiche di interesse oncologico”.

Conflicts of interest

None.

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Authors and Affiliations

  1. CNR Institute of Bioimaging and Molecular Physiology, Section of Genoa c/o Nuclear Medicine, Pad. Sommariva, IRCCS AOU San Martino-National Institute for Cancer Research, L.go R. Benzi, 10, 16132, Genoa, Italy

    Cecilia Marini

  2. National Council of Research, Naples, Italy

    Wanda Acampa

  3. Nuclear Medicine, Department of Health Science, University of Genoa, IRCCS-AOU San Martino-National Institute for Cancer Research, Genoa, Italy

    Matteo Bauckneht, Selene Capitanio, Francesco Fiz, Bassam Dib & Gianmario Sambuceti

  4. Nuclear Medicine, University Federico II, Naples, Italy

    Stefania Daniele, Valeria Cantoni, Emilia Zampella, Roberta Assante & Alberto Cuocolo

  5. Epidemiology Unit, IRCCS AOU San Martino-National Institute for Cancer Research, Genoa, Italy

    Paolo Bruzzi

Authors
  1. Cecilia Marini
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  2. Wanda Acampa
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  3. Matteo Bauckneht
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  13. Alberto Cuocolo
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Correspondence to Cecilia Marini.

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Marini, C., Acampa, W., Bauckneht, M. et al. Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity. Eur J Nucl Med Mol Imaging 42, 750–760 (2015). https://doi.org/10.1007/s00259-014-2963-8

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  • DOI: https://doi.org/10.1007/s00259-014-2963-8

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