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Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We assessed the prognostic value of coronary flow reserve (CFR) estimated by single-photon emission computed tomography (SPECT) in patients with suspected myocardial ischemia.

Methods and Results

Myocardial perfusion and CFR were assessed in 106 patients using dipyridamole/rest Tc-99m sestamibi SPECT and follow-up was obtained in 103 (97%) patients. Four early revascularized patients were excluded and 99 were assigned to normal (summed stress score <3) vs abnormal myocardial perfusion and to normal (≥2.0) vs abnormal CFR. During the follow-up (5.8 ± 2.1 years), 28 patients experienced a cardiac event (cardiac death, nonfatal myocardial infarction, and late revascularization). Abnormal perfusion (P < .01) and abnormal CFR (P < .05) were independent predictors of cardiac events at Cox proportional hazard regression analysis. Also in patients with normal perfusion, abnormal CFR was associated with a higher annual event rate compared with normal CFR (5.2% vs 0.7%; P < .05). CFR data improved the prognostic power of the model including clinical and myocardial perfusion data increasing the global chi-square from 18.6 to 22.8 (P < .05). Finally, at parametric survival analysis, in patients with normal perfusion the time to achieve ≥2% risk of events was >60 months in those with normal and <12 months in those with abnormal CFR.

Conclusions

Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.

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Acknowledgment

The authors have indicated they have no financial conflicts of interest.

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Authors and Affiliations

  1. SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy

    Stefania Daniele PhD & Alberto Cuocolo MD

  2. Department of Biomorphological and Functional Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

    Carmela Nappi MD, Francesca Ricci MD, Evgjeni Xhoxhi MD, Francesco Porcaro MD & Alberto Cuocolo MD

  3. Institute of Biostructures and Bioimages of the National Council of Research, Naples, Italy

    Wanda Acampa MD, PhD, Giovanni Storto MD, PhD, Teresa Pellegrino MD, PhD & Alberto Cuocolo MD

  4. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy

    Mario Petretta MD

Authors
  1. Stefania Daniele PhD
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  2. Carmela Nappi MD
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  3. Wanda Acampa MD, PhD
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  4. Giovanni Storto MD, PhD
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  5. Teresa Pellegrino MD, PhD
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  6. Francesca Ricci MD
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  7. Evgjeni Xhoxhi MD
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  8. Francesco Porcaro MD
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  9. Mario Petretta MD
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  10. Alberto Cuocolo MD
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Corresponding author

Correspondence to Alberto Cuocolo MD.

Additional information

See related editorial, doi:10.1007/s12350-011-9408-6.

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Daniele, S., Nappi, C., Acampa, W. et al. Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography. J. Nucl. Cardiol. 18, 612–619 (2011). https://doi.org/10.1007/s12350-011-9345-4

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  • DOI: https://doi.org/10.1007/s12350-011-9345-4

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