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Author Notes:

Address for correspondence: Daniel S. Berman MD FACC, Department of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, California 90048, Tel: +1-310-4234223, Fax: +1-310-4230811, bermand@cshs.org.

Cedars-Sinai Medical Center receives royalties for the quantitative assessment of function, perfusion, and viability, a portion of which is distributed to some of the authors of this manuscript (Daniel S. Berman, Guido Germano and Piotr Slomka).

No other potential conflict of interest relevant to this article was reported.

Subjects:

Research Funding:

Dr. Nakanishi was supported in part by research fellowship awards from the Society of Nuclear Medicine and Toho University School of Medicine, Tokyo, Japan.

This research was supported in part by grants R01HL089765 and 5K23HL92299 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH).

This work was also supported by grants to Dr. Berman from the Jane and Michael Eisner, and the Diane and Guilford Glazer Foundations.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Radiology, Nuclear Medicine & Medical Imaging
  • Cardiovascular System & Cardiology
  • Single-photon emission computed tomography myocardial perfusion imaging
  • SPECT-MPI
  • High risk of coronary artery disease
  • EMISSION COMPUTED-TOMOGRAPHY
  • TRANSIENT ISCHEMIC DILATION
  • INCREMENTAL PROGNOSTIC VALUE
  • AMERICAN-HEART-ASSOCIATION
  • HEALTH-CARE PROFESSIONALS
  • FRACTIONAL FLOW RESERVE
  • ALL-CAUSE MORTALITY
  • LEFT-VENTRICLE
  • EJECTION FRACTION
  • LARGE POPULATION

Predictors of high-risk coronary artery disease in subjects with normal SPECT myocardial perfusion imaging

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Journal Title:

Journal of Nuclear Cardiology

Volume:

Volume 23, Number 3

Publisher:

, Pages 530-541

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: While uncommon, normal stress SPECT myocardial perfusion imaging (MPI) can be seen in patients with high-risk coronary artery disease (CAD) by invasive coronary angiography (ICA).The predictors of high-risk CAD in patients with normal SPECT-MPI have not been described. Methods: We studied 580 patients (age 64 ± 12 years, 49% men) without known CAD who underwent stress-gated SPECT-MPI [exercise (41%) or vasodilator (59%)] <2 months before ICA and had summed stress score (SSS) <4. High-risk CAD was defined as 3 vessels with ≥70% stenosis, 2 vessels with ≥70% stenosis including proximal left anterior descending, or left main with ≥50% stenosis. Obstructive non-high-risk CAD was defined by the presence of a ≥70% stenosis but without having other high-risk criteria. Tenfold cross-validated receiver operating characteristic (ROC) estimates were obtained to assess the predictors of high-risk CAD. Results: Forty-two subjects (7.2%) had high-risk CAD and 168 (29.0%) had obstructive non-high-risk CAD. Variables associated with high-risk CAD were pretest probability of CAD ≥66% (Odds ratio [OR] 3.63, 95% CI 1.6-8.3, P = .002), SSS > 0 (OR 7.46, 95% CI 2.6-21.1, P < 0.001), and abnormal TID (OR 2.16, 95% CI 1.0-4.5, P = 0.044). When substituted for TID, EF change was also predictive of high-risk CAD (OR 0.93, 95% CI 0.9-1.0, P = 0.023). The prevalence of high-risk CAD increased as the number of these predictors increased. In a sub-analysis of patients in whom quantitative total perfusion deficit (TPD) was available, TPD > 0 was also a predictor of high-risk CAD (OR 6.01, 95% CI 1.5-22.2, P = 0.011). Conclusion: Several clinical, stress, and SPECT-MPI findings are associated high-risk CAD among patients with normal SPECT-MPI. Consideration of these factors may improve the overall assessment of the likelihood of high-risk CAD in patients undergoing stress SPECT-MPI.

Copyright information:

© 2015, American Society of Nuclear Cardiology.

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