Skip to main content

Advertisement

SpringerLink
Log in

Nomograms for estimating coronary artery disease prognosis with gated stress myocardial perfusion SPECT

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Nomograms can be useful tools for estimating coronary artery disease (CAD) risk. We sought to devise risk-based nomograms for stress myocardial perfusion SPECT to include measures of % ischemic myocardium and left ventricular function.

Methods

A total of 4,575 patients were consecutively and prospectively enrolled in the Myoview Prognosis Registry. Multivariable Cox proportional hazards model were employed to estimate CAD death or MI. Nomograms were devised from the results of the Cox models.

Results

CAD death or MI rates worsened in a gradient manner by the % ischemic myocardium. Higher risk patients were those with a rest and/or post-stress LVEF ≤ 45%. A nomogram was developed to estimate 2-year CAD death or MI-free survival for exercising and pharmacologic stress patients by their post-stress LVEF and % ischemic myocardium MPS results. Patients undergoing pharmacologic stress with a rest and/or post-stress LVEF ≤ 45% with high risk ischemic findings had the lowest CAD death or MI event-free survival. For exercising patients with a preserved resting LVEF > 45%, 2-year CAD death or MI event-free survival ranged from 99.4% to 89% for 0% to ≥20% ischemic myocardium. Those at highest risk included patients undergoing pharmacologic stress with depressed LVEF. For pharmacologic stress patients with a resting LVEF ≤45%, 2-year CAD death or MI event-free survival ranged from 89% to 48% for 0% to ≥20% ischemic myocardium. For pharmacologic stress patients with a post-stress LVEF ≤ 45%, 2-year CAD death or MI event-free survival ranged from 88% to 46% for 0% to ≥20% ischemic myocardium. A validation cohort revealed moderate-strong correlation between observed and predicted survival (r = 0.71). Average discordance between observed and predicted survival was ≤2% but was greater for higher risk patients with lower predicted survival estimates.

Conclusions

Risk-based nomograms estimating important CAD outcomes may serve as a clinically useful tool to target therapeutic intervention for high risk patient subsets.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Shaw LJ, Marwick TH, Zoghbi WA, Hundley WG, Kramer CM, Achenbach S, et al. Why all the focus on cardiac imaging? JACC Cardiovasc Imaging 2010;3:789-94.

    Article  PubMed  Google Scholar 

  2. Shaw LJ, Min JK, Hachamovitch R, Peterson ED, Hendel RC, Woodard PK, et al. Cardiovascular imaging research at the crossroads. JACC Cardiovasc Imaging 2010;3:316-24.

    Article  PubMed  Google Scholar 

  3. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy. J Am Coll Cardiol 2005;45:722-9.

    Article  PubMed  Google Scholar 

  4. Shaw LJ, Wilson PW, Hachamovitch R, Hendel RC, Borges-Neto S, Berman DS. Improved near-term coronary artery disease risk classification with gated stress myocardial perfusion SPECT. JACC Cardiovasc Imaging 2010;3:1139-48.

    Article  PubMed  Google Scholar 

  5. Shaw LJ, Hendel RC, Cerquiera M, Mieres JH, Alazraki N, Krawczynska E, et al. Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005;45:1494-504.

    Article  PubMed  Google Scholar 

  6. Shaw LJ, Hendel R, Borges-Neto S, Lauer MS, Alazraki N, Burnette J, et al. Prognostic value of normal exercise and adenosine (99m)tc-tetrofosmin SPECT imaging: Results from the multicenter registry of 4, 728 patients. J Nucl Med 2003;44:134-9.

    PubMed  Google Scholar 

  7. Shaw LJ, Hendel RC, Heller GV, Borges-Neto S, Cerqueira M, Berman DS. Prognostic estimation of coronary artery disease risk with resting perfusion abnormalities and stress ischemia on myocardial perfusion SPECT. J Nucl Cardiol 2008;15:762-73.

    PubMed  Google Scholar 

  8. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: Summary article. A report of the American College of Cardiology/American Heart Association Task Force On Practice Guidelines (committee to update the 1997 exercise testing guidelines). J Am Coll Cardiol 2002;40:1531-40.

    Article  PubMed  Google Scholar 

  9. Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, et al. Myocardial perfusion and function: Single photon emission computed tomography. J Nucl Cardiol 2007;14:e39-60.

    Article  PubMed  Google Scholar 

  10. Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LE, Friedman JD, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. Medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J 2011;32:1012-24.

    Article  PubMed  Google Scholar 

  11. Hachamovitch R, Rozanski A, Hayes SW, Thomson LE, Germano G, Friedman JD, et al. Predicting therapeutic benefit from myocardial revascularization procedures: Are measurements of both resting left ventricular ejection fraction and stress-induced myocardial ischemia necessary? J Nucl Cardiol 2006;13:768-78.

    Article  PubMed  Google Scholar 

  12. Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, McCants CB, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991;325:849-53.

    Article  PubMed  CAS  Google Scholar 

  13. Garg S, Sarno G, Garcia-Garcia HM, Girasis C, Wykrzykowska J, Dawkins KD, et al. A new tool for the risk stratification of patients with complex coronary artery disease: The clinical syntax score. Circ Cardiovasc Interv 2010;3:317-26.

    Article  PubMed  Google Scholar 

  14. Wykrzykowska JJ, Garg S, Girasis C, de Vries T, Morel MA, van Es GA, et al. Value of the syntax score for risk assessment in the all-comers population of the randomized multicenter leaders (limus eluted from a durable versus erodable stent coating) trial. J Am Coll Cardiol 2010;56:272-7.

    Article  PubMed  Google Scholar 

  15. Chakravarty T, Buch MH, Naik H, White AJ, Doctor N, Schapira J, et al. Predictive accuracy of syntax score for predicting long-term outcomes of unprotected left main coronary artery revascularization. Am J Cardiol 2011;107:360-6.

    Article  PubMed  Google Scholar 

  16. Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, et al. The TIMI risk score for unstable angina/non-ST elevation mi: A method for prognostication and therapeutic decision making. JAMA 2000;284:835-42.

    Article  PubMed  CAS  Google Scholar 

  17. Sanchis J, Bodi V, Nunez J, Bertomeu-Gonzalez V, Gomez C, Bosch MJ, et al. New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: A comparison with the TIMI risk score. J Am Coll Cardiol 2005;46:443-9.

    Article  PubMed  CAS  Google Scholar 

  18. Morrow DA, Antman EM, Parsons L, de Lemos JA, Cannon CP, Giugliano RP, et al. Application of the TIMI risk score for ST-elevation mi in the national registry of myocardial infarction 3. JAMA 2001;286:1356-9.

    Article  PubMed  CAS  Google Scholar 

  19. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol 2004;11:171-85.

    Article  PubMed  Google Scholar 

  20. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: Differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-43.

    PubMed  CAS  Google Scholar 

  21. Berman DS, Kang X, Hayes SW, Friedman JD, Cohen I, Abidov A, et al. Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management. J Am Coll Cardiol 2003;41:1125-33.

    Article  PubMed  Google Scholar 

  22. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. 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;43:200-8.

    Article  PubMed  Google Scholar 

  23. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-16.

    Article  PubMed  CAS  Google Scholar 

  24. Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, MacGregor JM, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009;360:2503-15.

    Article  PubMed  CAS  Google Scholar 

  25. Iskandrian AS, Johnson J, Le TT, Wasserleben V, Cave V, Heo J. Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment. J Nucl Cardiol 1994;1:144-9.

    Article  PubMed  CAS  Google Scholar 

  26. Shaw LJ, Peterson ED, Shaw LK, Kesler KL, DeLong ER, Harrell FE Jr, et al. Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. Circulation 1998;98:1622-30.

    PubMed  CAS  Google Scholar 

  27. Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med 1987;106:793-800.

    PubMed  CAS  Google Scholar 

  28. Califf RM, Armstrong PW, Carver JR, D’Agostino RB, Strauss WE. 27th Bethesda conference: Matching the intensity of risk factor management with the hazard for coronary disease events. Task force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol 1996;27:1007-19.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Rd NE, Room 530, Atlanta, GA, 30306, USA

    Leslee J. Shaw PhD

  2. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    James K. Min MD & Daniel S. Berman MD

  3. Cleveland Clinic Foundation, Cleveland, OH, USA

    Rory Hachamovitch MD, MS

  4. University of Miami, Miami, FL, USA

    Robert C. Hendel MD

  5. Duke University, Durham, NC, USA

    Salvador Borges-Neto MD

Authors
  1. Leslee J. Shaw PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James K. Min MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rory Hachamovitch MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert C. Hendel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Salvador Borges-Neto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel S. Berman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leslee J. Shaw PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shaw, L.J., Min, J.K., Hachamovitch, R. et al. Nomograms for estimating coronary artery disease prognosis with gated stress myocardial perfusion SPECT. J. Nucl. Cardiol. 19, 43–52 (2012). https://doi.org/10.1007/s12350-011-9468-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-011-9468-7

Keywords

Search

Navigation