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Journal of Nuclear Cardiology

, Volume 26, Issue 1, pp 92–106 | Cite as

The impact of combined cardiopulmonary exercise testing and SPECT myocardial perfusion imaging on downstream evaluation and management

  • Georgios Christopoulos
  • John Bois
  • Thomas G. Allison
  • Martin Rodriguez-Porcel
  • Panithaya ChareonthaitaweeEmail author
Original Article

Abstract

Objective

The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study.

Methods

We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect. The primary study outcome was change in clinical decision-making after CPET-MPI including management of pulmonary disease, management of deconditioning, heart failure management, and referral for cardiac catheterization. Outcomes of patients with normal and abnormal MPI were presented based on the specific CPET abnormality.

Results

415 patients were included in the study. Of the 269 patients that had normal MPI, 206 (77%) had abnormal CPET. Patients with abnormal CPET and normal MPI, compared with patients that had normal CPET and normal MPI, were more frequently diagnosed with pulmonary disease (11.7% vs 3.2%, P = .04) and deconditioning (33.5% vs 17.4%, P = .01). Of the 146 patients that had abnormal MPI, 128 (88%) had abnormal CPET. Patients with abnormal CPET and abnormal MPI, compared with patients that had normal CPET and abnormal MPI, did not statistically differ with regard to the study outcome.

Conclusion

An abnormal CPET, if the MPI was normal, prompted further evaluation and led to management of pulmonary disease and deconditioning.

Keywords

Myocardial perfusion imaging cardiopulmonary testing clinical outcomes 

Abbreviations

CPET

Cardiopulmonary exercise testing

MPI

Myocardial perfusion imaging

SPECT

Single-photon emission computed tomography

MET

Metabolic equivalents

FAC

Functional aerobic capacity

VO2

Oxygen consumption

VE

Minute ventilation

VCO2

Carbon dioxide production

RER

Respiratory exchange ratio

Notes

Disclosure

All authors declare that they have no conflict of interest.

Supplementary material

12350_2017_910_MOESM1_ESM.pdf (40 kb)
Supplementary material 1 (PDF 40 kb)
12350_2017_910_MOESM2_ESM.pptx (308 kb)
Supplementary material 1 (PPT 309 kb)

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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Georgios Christopoulos
    • 1
  • John Bois
    • 2
  • Thomas G. Allison
    • 2
  • Martin Rodriguez-Porcel
    • 2
  • Panithaya Chareonthaitawee
    • 2
    Email author
  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Department of Cardiovascular MedicineMayo ClinicRochesterUSA

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