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Influence of 99mTc-tetrofosmin SPECT myocardial perfusion imaging on the prediction of future adverse cardiac events

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The impact of myocardial perfusion imaging (MPI) on prediction of risk for future cardiac events was examined by comparing predictions based on clinical information alone and in combination with MPI findings.

Methods and Results

A 3-cardiologist Cardiac Event Prediction Panel (CEPP) estimated three-year cardiac event (non-fatal MI; aborted sudden cardiac death; cardiac death) risk based on clinical data (C) for 371 subjects. CEPP repeated this estimation after receiving Summed Stress Scores (SSS) and Summed Rest Scores (SRS) from blinded reading of rest-stress 99mTc-tetrofosmin MPI SPECT studies (C + MPI). The C and C + MPI estimates were then compared with three-year and total event rates. MPI was normal (SSS ≤ 3) in 227 patients (61%), mildly abnormal (SSS 4-8) in 31 (8%), moderately abnormal (SSS 9-13) in 36 (10%), and severely abnormal (SSS > 13) in 77 (21%). Eighteen cardiac events occurred within 3 years and 33 occurred during a mean follow-up of 3.9 years. C + MPI estimates of low risk (<1-1.5%/year) identified significantly more patients who did not have events than C. C + MPI three-year event-rate predictions were more accurate than those made with C (P < .01). C + MPI categorization also provided better delineation of incremental risk on time-to-event analyses.

Conclusions

99mTc-tetrofosmin MPI single photon emission computed tomography (SPECT) findings significantly improve accuracy of cardiac event rate prediction compared to those based on clinical information alone.

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Acknowledgments

The authors would like to acknowledge the contribution of the following trial participants. Naomi Alazraki, MD, Atlanta VA Medical Center; Raye Bellinger, MD, Sacramento Heart & Vascular Research Center; Salvador Borges-Neto, MD, Duke University Medical Center; Veronica Covalesky, MD, Cardiology Consultants of Philadelphia; William Ganz, MD, Diagnostic Testing Group of Miami; Gary V. Heller, MD, PhD, Hartford Hospital; Ami E. Iskandrian, MD, The University of Alabama at Birmingham; Robert L. Jesse, MD, PhD, Richmond VA Medical Center; Paul R. Jolles, MD, Virginia Commonwealth University Medical Center; Phillip A. Koren, MD, Cardiovascular Associates of the Delaware Valley; Jeffrey H. Kramer, MD, Cardiovascular Associates of the Delaware Valley; Kenneth D. Mendel, MD, Cardiology Consultant of Philadelphia; Hani H. Abdel-Nabi, MD, University of Buffalo; J. Anthony Parker, MD, PhD, Beth Israel Deaconess Medical Center; William VanDecker, MD, Temple University Hospital; Kim Allan Williams, MD, FACC, FCCP, FAHA, University of Chicago Medical Center; Andrew Wong, MD, Cardiology Consultants of Napa Valley; Thomas C. Hilton, MD, FACC, Jacksonville Heart Center; Scott Jerome, DO, Mid-Atlantic Cardiovascular Associates; James R. Corbett, MD, University of Michigan Medical Ctr; Mary N. Walsh, MD, The Care Group, LLC; Paul W. Farrell, MD, FACC, Jacksonville Heart Center, PA. Disclousures: Dr Diwakar Jain has served as a consultant for GE Healthcare and is on the speakers’ bureau of GE Healthcare. Drs Fred Weiland and Steven Edell have served as investigators and consultants for GE Healthcare. Drs Harry Lessig, Riti Patel, Leonard Sandler, Elizabeth Oates, and Erin O’Malley-Tysko have served as consultants for GE Healthcare. Dr Arnold F Jacobson and Ms Natalie Khutoryansky are employees of GE Healthcare.

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Diwakar Jain MD, FACC, FRCP & Riti Patel MD

  2. Deborah Hospital, Browns Mills, NJ, USA

    Harry Lessig MD

  3. Farmingdale, NJ, USA

    Leonard Sandler MD

  4. Sutter Roseville Hospital, Roseville, CA, USA

    Fred Weiland MD

  5. Women’s Imaging Center of Delaware, Newark, DE, USA

    Steven L. Edell DO, FACR

  6. University of Kentucky Medical Center, Lexington, KY, USA

    M. Elizabeth Oates MD

  7. Blue Bell, PA, USA

    Erin O’Malley-Tysko MD

  8. GE Healthcare, 101 Carnegie Center, Princeton, NJ, 08540, USA

    Natalie Khutoryansky MA & Arnold F. Jacobson MD, PhD

Authors
  1. Diwakar Jain MD, FACC, FRCP
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  2. Harry Lessig MD
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  3. Riti Patel MD
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  4. Leonard Sandler MD
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  5. Fred Weiland MD
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  6. Steven L. Edell DO, FACR
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  7. M. Elizabeth Oates MD
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  8. Erin O’Malley-Tysko MD
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  9. Natalie Khutoryansky MA
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  10. Arnold F. Jacobson MD, PhD
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Corresponding author

Correspondence to Arnold F. Jacobson MD, PhD.

Additional information

This study was performed by GE Healthcare.

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Jain, D., Lessig, H., Patel, R. et al. Influence of 99mTc-tetrofosmin SPECT myocardial perfusion imaging on the prediction of future adverse cardiac events. J. Nucl. Cardiol. 16, 540–548 (2009). https://doi.org/10.1007/s12350-009-9080-2

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  • DOI: https://doi.org/10.1007/s12350-009-9080-2

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