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Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: Gender-related differences in normal limits and outcomes

  • Original Articles
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Whether there are gender differences in the prognostic application of gated myocardial perfusion single photon emission computed tomography (SPECT) has not been assessed. asMethods and Results

Gender-specific normal limits of poststress volume and ejection fraction (EF) were obtained in 597 women and 824 men with a low likelihood of coronary artery disease and normal perfusion and were applied in a prognostic evaluation of 6713 patients (2735 women and 3978 men). Patients underwent rest thallium-201/stress technetium-99m sestamibi gated myocardial perfusion SPECT and were followed up for 35 ± 14 months. The upper limit of the end-systolic volume (ESV) index was 27 mL/m2 in women and 39 mL/m2 in men, and the upper limit of the end-diastolic volume index was 60 mL/m2 in women and 75 mL/m2 in men. The lower limit of the EF was 51% in women and 43% in men. Gated SPECT variables provided incremental prognostic information in both genders. Women with severe ischemia and an EF lower than 51% or an ESV index greater than 27 mL/m2 were at very high risk of cardiac death or myocardial infarction (3-year event rates of 39.8% and 35.1%, respectively), whereas women with severe ischemia but an EF of 51% or greater or an ESV index of 27 mL/m2 or less were at intermediate or high risk (3-year event rates of 10.8% and 15.2%, respectively).

Conclusion

Poststress EF and ESV index by gated myocardial perfusion SPECT provide comparable incremental prognostic information over perfusion in women and men. After separate criteria for abnormal EF and ESV index in women are used, the combination of severe ischemia and abnormal EF or ESV index identifies women at very high risk of cardiac events.

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Authors and Affiliations

  1. Department of Imaging, Division of Nuclear Medicine, Department of Medicine, Division of Cardiology, and Burns and Allen Research Institute, Cedars-Sinai Medical Center, USA

    Tali Sharir, Xingping Kang, Leslee J. Shaw, Heidi Gransar, Ishac Cohen, Guido Germano, Sean W. Hayes, John D. Friedman & Daniel S. Berman

  2. Department of Imaging, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 1258, 90048, Los Angeles, CA

    Guido Germano, Sean W. Hayes, John D. Friedman & Daniel S. Berman

  3. Los Angeles, Calif, and Leiden University Medical Center, Leiden, The Netherlands

    Jeroen J. Bax

Authors
  1. Tali Sharir
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  2. Xingping Kang
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  3. Leslee J. Shaw
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  4. Heidi Gransar
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  5. Ishac Cohen
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  6. Guido Germano
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  7. Sean W. Hayes
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  8. John D. Friedman
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  9. Daniel S. Berman
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Corresponding author

Correspondence to Daniel S. Berman.

Additional information

Partial funding was provided by grants from Bristol-Myers Squibb Medical Imaging, Inc, Billerica, Mass, and Astellas Pharma US, Inc, Deerfield, Ill.

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Sharir, T., Kang, X., Shaw, L.J. et al. Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: Gender-related differences in normal limits and outcomes. J Nucl Cardiol 13, 495–506 (2006). https://doi.org/10.1016/j.nuclcard.2006.03.019

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  • DOI: https://doi.org/10.1016/j.nuclcard.2006.03.019

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