Advances in nuclear imaging for preoperative risk assessment
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Myocardial perfusion imaging (MPI) is frequently utilized for preoperative risk assessment. Results are pertinent for longterm risk. MPI, though most frequently applied in intermediate-risk patients, may also be valuable in selected low- and high-risk individuals. Coronary stenting may alter the timing of noncardiac surgery, which should be considered when performing preoperative risk assessment.
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References and Recommended Reading
- 1.Eagle KA, Berger PB, Calkins H, et al.: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guideline (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). American College of Cardiology 2002. http:www.acc.org/clinical/guidelines/perio/dirIndex.htm. A position statement by ACC/AHA on the role for stress testing in perioperative cardiovascular risk evaluation. Describes current guidelines, which frame the environment for future studies evaluating risk assessment.Google Scholar
- 4.Poornima IG, Miller TD, Chrisitan TF, et al.: Utility of myocardial perfusion imaging in patients with low-risk treadmill scores. J Am Coll Cardiol 2004, 43:194–199. A retrospective analysis of symptomatic patients with low-risk treadmill scores who benefit from further clinical risk stratification and MPI to improve prognostic assessment.PubMedCrossRefGoogle Scholar
- 7.Hachamovitch R, Hayes SW, Friedman JD, et al.: Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol 2004, 43:200–208. Describes for the first time the utility of SPECT imaging in risk stratification of a high probability population for CAD with regard to prognosis and cost efficiency.PubMedCrossRefGoogle Scholar
- 13.Cohen MC, Siewers AE, Dickens JD Jr, et al.: Perioperative and long-term prognostic value of dipyridamole Tc-99m sestamibi myocardial tomography in patients evaluated for elective vascular surgery. J Nucl Cardiol 2003, 10:464–472. Demonstrates that using MIBI, LAD perfusion abnormalities are associated with poor long-term prognosis and that a normal scan confers low perioperative risk in patients awaiting elective vascular surgery.PubMedCrossRefGoogle Scholar
- 15.Hashimoto J, Suzuki T, Nakahara T, et al.: Preoperative risk stratification using stress myocardial perfusion scintigraphy with electrocardiographic gating. J Nucl Med 2003, 44:385–390. Demonstrated that ECG gating with SPECT myocardial perfusion confers an incremental prognostic value over conventional nongated stress perfusion imaging in predicting perioperative cardiac events.PubMedGoogle Scholar
- 19.Machecourt J, Longere P, Fagret D, et al.: Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect: study in 1,926 patients with follow-up at 33 months. J Am Coll Cardiol 1994, 23:1096–1106.PubMedCrossRefGoogle Scholar
- 21.Hachamovitch R, Hayes S, Friedman JD, et al.: Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: what is the warranty period of a normal scan? J Am Coll Cardiol 2003, 41:1329–1340. Quantifies risk factors associated with increased risk on normal stress myocardial perfusion scans and provides parametric data on the change in risk over time. Includes model for risk assessment after normal scan depending on age, sex, history of CAD, type of stress, and presence of diabetesPubMedCrossRefGoogle Scholar
- 22.Landesberg G, Mosseri M, Shatz V, et al.: Cardiac troponin after major vascular surgery: the role of perioperative ischemia, preoperative thallium scanning, and coronary revascularization. J Am Coll Cardiol 2004, 44:569–575. Demonstrated that low-level postoperative troponin elevations occur frequently after major vascular surgery, especially in patients with inducible ischemia on preoperative testing and that coronary revascularization does reduce but not eliminate this risk.PubMedCrossRefGoogle Scholar