Advertisement

Journal of Nuclear Cardiology

, Volume 12, Issue 6, pp 662–670 | Cite as

Incremental prognostic value of combined perfusion and function assessment during myocardial gated SPECT in patients aged 75 years or older

  • Olivier De Winter
  • Anja Velghe
  • Nico Van de Veire
  • Pieter De Bondt
  • Marc De Buyzere
  • Christophe Van De Wiele
  • Guy De Backer
  • Thierry C. Gillebert
  • Rudi A. Dierckx
  • Johan De Sutter
Article

Abstract

Background

Perfusion and functional data obtained during gated single photon emission computed tomography (SPECT) have proven prognostic value in the middle-aged patient population. The aim of this study was to investigate whether perfusion and functional cardiac gated SPECT data have prognostic value in patients aged 75 years or older.

Methods and Results

We studied clinical and gated SPECT predictors of cardiac and all-cause death in 294 patients aged 75 years or older with known or suspected coronary artery disease who were referred for tetrofosmin cardiac gated SPECT imaging. Summed perfusion scores were calculated in a 17-segment model by use of commercially available software (4D-MSPECT). Left ventricular functional data were calculated by use of QGS gated SPECT software. The median age of the study population was 78 years (range, 75–91 years). There were 160 men (54%) and 134 women (46%). During a median follow-up of 25.9 months (range, 1.8–36 months), 47 patients (16%) died (27 cardiac deaths). In a multivariate Cox proportional hazards regression analysis, the summed rest score (±2 gain ± 8.0, P ± .009), transient ischemic dilatation index (±2 gain ± 6.3, P ± .012), and resting left ventricular ejection fraction (±2 gain ± 7.0, P ± .030) were independent predictors of all-cause death. The summed rest score (±2 gain ± 8.2, P ± .004) and resting end-systolic volume (±2 gain ± 13.7, P ± .005) were independent predictors of cardiac death.

Conclusions

This study showed that gated SPECT left ventricular functional data assessed during myocardial gated SPECT provide independent and incremental information above clinical and perfusion SPECT data for the prediction of cardiac and all-cause death in patients aged 75 years or older referred for myocardial SPECT imaging.

Key Words

Single photon emission computed tomography coronary artery disease 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, et al. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 1999;100:1035–42.PubMedGoogle Scholar
  2. 2.
    Amanullah AM, Berman DS, Erel J, Kiat H, Cohen I, Germano G, et al. Incremental prognostic value of adenosine myocardial perfusion single-photon emission computed tomography in women with suspected coronary artery disease. Am J Cardiol 1998;82:725–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Candell-Riera J, Llevadot J, Santana C, Castell J, Aguade S, Armadans L, et al. Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT. J Nucl Cardiol 2001;8:122–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Galassi AR, Azzarelli S, Tomaselli A, Giosofatto R, Ragusa A, Musumeci S, et al. Incremental prognostic value of technetium- 99m-tetrofosmin exercise myocardial perfusion imaging for predicting outcomes in patients with suspected or known coronary artery disease. Am J Cardiol 2001;88:101–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996;93:905–14.PubMedGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    De Winter O, De Bondt P, Van de Wiele C, De Backer G, Dierckx RA, De Sutter J. Day-to-day variability of global left ventricular functional and perfusional measurements by quantitative gated SPECT using Tc-99m tetrofosmin in patients with heart failure due to coronary artery disease. J Nucl Cardiol 2004;11:47–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–47.PubMedGoogle Scholar
  9. 9.
    Iskandrian AE, Germano G, VanDecker W, Ogilby JD, Wolf N, Mintz R, et al. Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging. J Nucl Cardiol 1998;5:574–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.PubMedCrossRefGoogle Scholar
  12. 12.
    De Bondt P, Van de Wiele C, De Sutter J, De Winter F, De Backer G, Dierckx RA. Age- and gender-specific differences in left ventricular cardiac function and volumes determined by gated SPECT. Eur J Nucl Med 2001;28:620–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Berman DS, Kang X, Van Train KF, Lewin HC, Cohen I, Areeda J, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1998;32:1987–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Cohen Y, Acio E, Heo J, Hughes E, Narula J, Iskandrian AE. Comparison of the prognostic value of qualitative versus quantitative stress tomographic perfusion imaging. Am J Cardiol 1999; 83:945–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Elhendy A, Schinkel A, Bax JJ, van Domburg RT, Poldermans D. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol 2003;10:261–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Zerahn B, Jensen BV, Nielsen KD, Moller S. Increased prognostic value of combined myocardial perfusion imaging and exercise electrocardiography in patients with coronary artery disease. J Nucl Cardiol 2000;7:616–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Stratmann HG, Williams GA, Wittry MD, Chaitman BR, Miller DD. Exercise Tc-99m sestamibi tomography for cardiac risk stratification of patients with stable chest pain. Circulation 1994; 89:615–22.PubMedGoogle Scholar
  18. 18.
    Stratmann HG, Tamesis BR, Younis LT, Wittry MD, Miller DD. Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise. Am J Cardiol 1994;73:647–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Iskandrian AS, Heo J, Decoskey D, Askenase A, Segal BL. Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease. Am J Cardiol 1988;61:269–72.PubMedCrossRefGoogle Scholar
  20. 20.
    Steingart RM, Hodnett P, Musso J, Feuerman M. Exercise myocardial perfusion imaging in elderly patients. J Nucl Cardiol 2002;9:573–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Schinkel AF, Elhendy A, Biagini E, van Domburg RT, Valkema R, Rizello V, et al. Prognostic stratification using dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing. J Nucl Med 2005;46:12–8.PubMedGoogle Scholar
  22. 22.
    Shaw L, Chaitman BR, Hilton TC, Stocke K, Younis LT, Caralis DG, et al. Prognostic value of dipyridamole thallium-201 imaging in elderly patients. J Am Coll Cardiol 1992;19:1390–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Hilton TC, Shaw LJ, Chaitman BR, Stocke KS, Goodgold HM, Miller DD. Prognostic significance of exercise thallium-201 testing in patients aged greater than or equal to 70 years with known or suspected coronary artery disease. Am J Cardiol 1992;69:45–50.PubMedCrossRefGoogle Scholar
  24. 24.
    Lima RS, De Lorenzo A, Pantoja MR, Siqueira A. Incremental prognostic value of myocardial perfusion 99m-technetium-sestamibi SPECT in the elderly. Int J Cardiol 2004;93:137–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Valeti US, Miller TD, Hodge DO, Gibbons RJ. Exercise singlephoton emission computed tomography provides effective risk stratification of elderly men and elderly women. Circulation 2005;111:1771–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Lee KL, Pryor DB, Pieper KS, Harrell FE Jr, Califf RM, Mark DB, et al. Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables. Circulation 1990;82:1705–17.PubMedGoogle Scholar
  27. 27.
    Morris KG, Palmeri ST, Califf RM, McKinnis RA, Higginbotham MB, Coleman RE, et al. Value of radionuclide angiography for predicting specific cardiac events after acute myocardial infarction. Am J Cardiol 1985;55:318–24.PubMedCrossRefGoogle Scholar
  28. 28.
    Shaw LJ, Heinle SK, Borges-Neto S, Kesler K, Coleman RE, Jones RH. Prognosis by measurements of left ventricular function during exercise. Duke Noninvasive Research Working Group. J Nucl Med 1998;39:140–6.PubMedGoogle Scholar
  29. 29.
    White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987;76:44–51.PubMedGoogle Scholar
  30. 30.
    Galderisi M, Lauer MS, Levy D. Echocardiographic determinants of clinical outcome in subjects with coronary artery disease (the Framingham Heart Study). Am J Cardiol 1992;70:971–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Kuhn MB, Egeblad H, Hojberg S, Melchior T, Videbaek R, Sorum C, et al. Prognostic value of echocardiography compared to other clinical findings. Multivariate analysis based on long-term survival in 456 patients. Cardiology 1995;86:157–62.CrossRefGoogle Scholar
  32. 32.
    Quinones MA, Greenberg BH, Kopelen HA, Koilpillai C, Limacher MC, Shindler DM, et al. Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 2000;35:1237–44.PubMedCrossRefGoogle Scholar
  33. 33.
    Romano S, Dagianti A, Penco M, Varveri A, Biffani E, Fedele F, et al. Usefulness of echocardiography in the prognostic evaluation of non-Q-wave myocardial infarction. Am J Cardiol 2000;86:43G-45G.PubMedCrossRefGoogle Scholar
  34. 34.
    Wu KC, Zerhouni EA, Judd RM, Lugo-Olivieri CH, Barouch LA, Schulman SP, et al. Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction. Circulation 1998;97:765–72.PubMedGoogle Scholar
  35. 35.
    Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I, Gerlach J, et al. Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol 2003;42:1818–25.PubMedCrossRefGoogle Scholar
  36. 36.
    McLaughlin MG, Danias PG. Transient ischemic dilation: a powerful diagnostic and prognostic finding of stress myocardial perfusion imaging. J Nucl Cardiol 2002;9:663–7.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2005

Authors and Affiliations

  • Olivier De Winter
    • 1
  • Anja Velghe
    • 2
  • Nico Van de Veire
    • 3
  • Pieter De Bondt
    • 1
  • Marc De Buyzere
    • 3
  • Christophe Van De Wiele
    • 1
  • Guy De Backer
    • 4
  • Thierry C. Gillebert
    • 3
  • Rudi A. Dierckx
    • 1
  • Johan De Sutter
    • 3
  1. 1.Nuclear Medicine DivisionGhent University HospitalGhentBelgium
  2. 2.Departments of GeriatricsGhent University HospitalGhentBelgium
  3. 3.Departments of CardiologyGhent University HospitalGhentBelgium
  4. 4.Cardiac Rehabilitation CenterGhent University HospitalGhentBelgium

Personalised recommendations