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Prognostic value of one millisievert exercise myocardial perfusion imaging in patients without known coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

The aim of this study was to assess the prognostic value of normal ultra-low-dose exercise MPI with a CZT camera.

Methods

1901 consecutive patients without known CAD referred for exercise MPI with 1.8 MBq/kg (0.05 mCi) of Tc99m sestamibi or tetrofosmin and a CZT camera were included prospectively. Patients with an abnormal scan requiring an additional resting image (230) or a submaximal exercise test (271) were excluded. The 1400 remaining patients were followed for 39 months. The primary end-point was cardiac events (cardiac death, nonfatal myocardial infarction, and revascularization). The secondary end-point was noncardiac death.

Results

The mean injected activity was 145 ± 37 MBq (3.9 ± 1 mCi), the mean acquisition duration was 10 ± 0.7 minutes, and the mean effective dose was 0.91 ± 0.13 mSv. 1288 patients (92%) achieved full follow-up. We observed 22 cardiac events and 16 noncardiac deaths. The annualized rates were equivalent to 0.55% for cardiac events and 0.37% for noncardiac mortality.

Conclusions

Normal ultra-low-dose exercise MPI with a CZT camera has a high negative predictive value. The effective dose was less than 1 mSv, and the study thus allays concerns about radiation burden.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

CZT:

Cadmium-Zinc-Telluride

MPHR:

Maximal predicted heart rate

MPI:

Myocardial perfusion imaging

PTCA:

Percutaneous transluminal coronary angioplasty

SPECT:

Single-photon emission computed tomography

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Acknowledgments

We thank Laurence Merlin, clinical research technologist, who performed the follow-up phone survey.

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Correspondence to Bernard Songy MD.

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See related editorial, doi:10.1007/s12350-016-0639-4.

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Songy, B., Guernou, M., Hivoux, D. et al. Prognostic value of one millisievert exercise myocardial perfusion imaging in patients without known coronary artery disease. J. Nucl. Cardiol. 25, 120–130 (2018). https://doi.org/10.1007/s12350-016-0601-5

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  • DOI: https://doi.org/10.1007/s12350-016-0601-5

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