Cor Vasa 2008, 50(10):373-377 | DOI: 10.33678/cor.2008.135

Prognostic value of stress myocardial perfusion and left ventricular function imaging using single--photon emission tomography

Milan Kamínek^1,*, Iva Metelková¹, Miroslava Budíková¹, Eliška Sovová², Jan Lukl², Hana Študentová³

¹ Klinika nukleární medicíny

² I. interní klinika

³ Kardiochirurgická klinika, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

Aim: The aim of this study was to assess the potential for risk stratification using quantitative perfusion and left ventri-cular function parameters provided by gated SPECT imaging.

Methods: The study population comprised 402 patients who underwent stress SPECT followed by coronary angiography: 284 men, mean age 61 ± 10 years, 102 after previous myocardial infarction (MI), 182 after revascularization. A summed difference score (SDS), poststress and rest left ventricular ejection fraction (LVEF) and transient ischemic dilatation (TID) ratio were obtained through the use of 4D-MSPECT software. Postischemic left ventricular stunning was defined as the worsening of LVEF by exercise ≥ 6% and/or a TID ratio > 1.17. A hard cardiac event was defined as sudden cardiac death or non-fatal MI.

Results: During a mean follow-up of 24 ± 17 months, we recorded no cardiac deaths in 209 patients without a serious reversible perfusion defect (SDS < 2); the annual incidence of MI (1.2 %) was significantly higher in patients with post-ischemic stunning (3.5% vs. 0.6%, p < 0.05). In patients with a mild reversible defect (SDS 2-7), the incidence of MI was comparable with or without postischemic stunning (4.8% vs. 4.5%, p = NS); however, we recorded cardiac deaths in patients with postischemic stunning only (incidence 2.9% vs. 0% per year, p < 0.05). In patients with a severe reversible defect (SDS > 7), the annual incidence of hard cardiac events was nonsignificantly higher in patients with postischemic stunning (8.1% vs. 5.3% for nonfatal MI and 2.7% vs. 2.6% for cardiac death, p = NS).

Conclusion: Quantitative perfusion SPECT and signs of postischemic stunning enable the identification of high-risk patients.

Keywords: Perfusion gated SPECT; Risk stratification; Postischemic left ventricular stunning

Published: October 1, 2008  Show citation