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Effect of gender on cardiovascular risk stratification with ECG gated SPECT left ventricular volume indices and ejection fraction

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Optimal gender-specific risk prediction using ECG-gated SPECT left ventricular (LV) volumes and ejection fraction (EF) remains undefined despite reported gender differences in baseline LV function.

Methods

ECG-gated SPECT studies of 891 consecutively referred patients (43% women) were evaluated for LV end-systolic and diastolic volume indices (ESVI, EDVI) and EF. Effects of gender on prediction of hard cardiac events (HCE) and the combined endpoint of all-cause mortality or non-fatal infarction (ACMMI) were evaluated.

Results

Women had smaller ESVI (37 vs 55 mL/m2), EDVI (78 vs 99 mL/m2), and higher LVEF (56 vs 47%, P < 0.0001 for each) with equivalent rates of HCE (6.1%) and ACMMI (11.8%). HCE risk started at smaller ESVI and EDVI in women compared to men (P ≤ 0.05 for each). In women, ESVI 37 mL/m2 provided maximum HCE prediction compared to 53 mL/m2 in men. A 1 mL/m2 increase in ESVI was associated with a 2.9% increased HCE risk in women (P < 0.0001) and a 0.9% increased ACMMI risk in men (P = 0.03). Women with ESVI > 35 mL/m2 had HCE HR 12.0 compared to women with ESVI < 23 mL/m2.

Conclusion

LV volume indices and LVEF predict subsequent morbid clinical events in men and women. In women, risk of subsequent events started at smaller LV volume indices compared to men despite similar risk profiles.

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Acknowledgments

We acknowledge and thank Gladys P. Velarde MD for thoughtful review of the manuscript, and James P. Corsetti MD PhD for statistical consultation.

Orren Wexler’s participation was supported by a $3,000 summer research grant from the University of Rochester.

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Authors and Affiliations

  1. University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 679-N, Rochester, NY, 14642, USA

    Orren Wexler BS

  2. Cardiology Division, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 679-N, Rochester, NY, 14642, USA

    Scott R. Yoder MD, Leway Chen MD, MPH & Ronald G. Schwartz MD, MS

  3. Division of Nuclear Medicine, Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Ronald G. Schwartz MD, MS

  4. Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642, USA

    Jessica L Elder MPH

  5. Nuclear Cardiology Laboratory, Cardiology Division, Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 679-N, Rochester, NY, 14642, USA

    Maria L. Mackin MS, CNMT

  6. GE Healthcare, Milwaukee, WI, USA

    Lonnie Mixon

Authors
  1. Orren Wexler BS
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  2. Scott R. Yoder MD
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  3. Jessica L Elder MPH
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  4. Maria L. Mackin MS, CNMT
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  5. Leway Chen MD, MPH
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  6. Lonnie Mixon
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  7. Ronald G. Schwartz MD, MS
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Corresponding author

Correspondence to Ronald G. Schwartz MD, MS.

Additional information

Orren Wexler, Scott Yoder, Jessica Elder, Maria Mackin, Leway Chen, Lonnie Mixon and Ronald Schwartz contributed to the conception and design of the study and/or the analysis and interpretation of the data and writing of the manuscript.

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Wexler, O., Yoder, S.R., Elder, J.L. et al. Effect of gender on cardiovascular risk stratification with ECG gated SPECT left ventricular volume indices and ejection fraction. J. Nucl. Cardiol. 16, 28–37 (2009). https://doi.org/10.1007/s12350-008-9000-x

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  • DOI: https://doi.org/10.1007/s12350-008-9000-x

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