INTRODUCTION: Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing. METHODS: We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions. RESULTS: We identified 11 studies suitable for review. A low-risk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 - 7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time. CONCLUSION AND CLINICAL IMPLICATIONS: A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.
INTRODUCTION: Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing. METHODS: We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions. RESULTS: We identified 11 studies suitable for review. A low-risk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 - 7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time. CONCLUSION AND CLINICAL IMPLICATIONS: A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.
Authors: E I Skalidis; G E Kochiadakis; S I Koukouraki; S I Chrysostomakis; N E Igoumenidis; N S Karkavitsas; P E Vardas Journal: J Am Coll Cardiol Date: 2001-01 Impact factor: 24.094
Authors: T Sharir; C Bacher-Stier; S Dhar; H C Lewin; R Miranda; J D Friedman; G Germano; D S Berman Journal: Am J Cardiol Date: 2000-12-01 Impact factor: 2.778
Authors: R G Groutars; J F Verzijlbergen; A J Muller; C A Ascoop; M M Tiel-van Buul; A H Zwinderman; N M van Hemel; E E van der Wall Journal: J Nucl Cardiol Date: 2000 Jul-Aug Impact factor: 5.952
Authors: A Elhendy; F B Sozzi; R T van Domburg; J J Bax; M L Geleijnse; R Valkema; E P Krenning; J R Roelandt Journal: J Nucl Cardiol Date: 2000 Sep-Oct Impact factor: 5.952
Authors: M L Geleijnse; C Vigna; J D Kasprzak; R Rambaldi; M P Salvatori; A Elhendy; J H Cornel; P M Fioretti; J R Roelandt Journal: Eur Heart J Date: 2000-10 Impact factor: 29.983
Authors: Tim J F ten Cate; Johannes C Kelder; Herbert W M Plokker; J Fred Verzijlbergen; Norbert M van Hemel Journal: J Nucl Cardiol Date: 2009-12-24 Impact factor: 5.952