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Outcome of patients with high-risk Duke treadmill score and normal myocardial perfusion imaging on spect

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Annual mortality rate can range from <1% for patients with normal myocardial perfusion by SPECT to >5% based on a high-risk Duke treadmill score (DTS). Information on the prognosis of patients with the combination of HRDTS and normal SPECT is limited and is the purpose of this study.

Methods

Data from a large nuclear cardiology registry (n = 17,972 patients) were reviewed. A total of 340 had HRDTS (score ≤ −11) while undergoing SPECT. Combined cardiovascular mortality and non-fatal myocardial infarction (MI) and cardiovascular mortality alone were available in 310 patients at a mean follow-up of 4.01 ± 1.5 years.

Results

The majority of the patients had abnormal SPECT (n = 270, 71%). The abnormal SPECT patients compared to the normal were older (65.6 vs 62.8 years of age; P = .025), more likely to have abnormal left ventricular ejection fraction (26.1% vs 0%; P < .0001), known coronary artery disease (CAD, 35.9% vs 7.8%; P < .0001) and lower DTS (−14.5 vs −13.2; P = .0006), Kaplan-Meier survival analysis demonstrated a significantly lower cardiovascular mortality (5.4% vs 0%, P = .02) and combined outcome of MI and cardiovascular mortality (15% vs 4.4%, P = .009) in patients with normal versus abnormal SPECT.

Conclusions

High-risk DTS is associated with abnormal perfusion SPECT in most patients, but nearly one-third of the patients had normal perfusion. Patients with a normal SPECT had a lower cardiovascular event rates.

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Abbreviations

SPECT:

Single photon-emission computed tomography

MPI:

Myocardial perfusion imaging

DTS:

Duke treadmill score

CAD:

Coronary artery disease

CV:

Cardiovascular

LV:

Left ventricular

MI:

Myocardial infarction

STD:

ST segment deviation

METS:

Metabolic equivalents

SSS:

Summed stress score

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Disclosure

The authors have indicated that they have no financial conflict of interest.

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Authors and Affiliations

  1. Universidade Federal do Paraná, Curitiba, Brazil

    Mauro R. B. Wanderley Jr. MD, Cláudio L. Pereira da Cunha MD, PhD & Isabella Shin-Ike MD

  2. Quanta – Diagnóstico e Terapia, R. Almirante Tamandaré, 1000, Curitiba, PR, CEP 80045-170, Brazil

    João V. Vítola MD, PhD, Rodrigo J. Cerci MD, Carlos C. Pereira Neto MD, Otávio Kormann MD, Olímpio França Neto MD, José Antônio da Silva MD & Arnaldo L. Stier MD

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  1. João V. Vítola MD, PhD
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Correspondence to João V. Vítola MD, PhD.

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See related editorial, doi:10.1007/s12350-015-0187-3.

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Vítola, J.V., Wanderley, M.R.B., Cerci, R.J. et al. Outcome of patients with high-risk Duke treadmill score and normal myocardial perfusion imaging on spect. J. Nucl. Cardiol. 23, 1291–1300 (2016). https://doi.org/10.1007/s12350-015-0156-x

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