Andrew J Einstein1, Lynne L Johnson2, Albert J DeLuca2, Andrew C Kontak2, Daniel W Groves2, Jennifer Stant2, Ted Pozniakoff2, Bin Cheng3, LeRoy E Rabbani2, Sabahat Bokhari2. 1. Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; and andrew.einstein@columbia.edu. 2. Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York. 3. Department of Biostatistics, Columbia University, New York, New York.
Abstract
UNLABELLED: Although SPECT myocardial perfusion imaging (MPI) provides valuable information about patients with chest pain, there is growing concern regarding its radiation burden and lengthy duration. New high-efficiency (HE) cameras and stress-first protocols both offer the potential to markedly reduce radiation. No previous study has assessed outcomes and radiation doses of patients undergoing MPI on an HE-SPECT camera using an ultra-low-dose stress-first protocol. METHODS: One hundred patients presenting to the emergency department with chest pain who were candidates for stress-first MPI underwent injection of approximately 185 MBq (5 mCi) of (99m)Tc-tetrofosmin at peak stress, followed by supine and prone imaging on an HE-SPECT camera. Same-day rest imaging was performed on patients with any abnormality on imaging after stress. Radiation effective dose was calculated from administered and residual activities. Patients were contacted 3 mo after discharge, and electronic records were accessed to evaluate the need for reevaluation for chest pain, additional imaging, or cardiac events. RESULTS: Stress-only imaging was performed in 69 patients, for whom radiation effective dose averaged 0.99 mSv and study duration, 117 min. Radiation dose averaged 2.22 mSv over all patients. At 3 mo, 96 patients were free of major adverse cardiac events, repeat hospital chest pain evaluation, and repeat imaging or stress testing. One year after MPI and hospital discharge, all patients were living and without acute coronary syndrome. CONCLUSION: HE-SPECT stress-only imaging can be performed in more than two thirds of chest pain patients without a high pretest probability of a stress perfusion defect, with excellent prognosis, a radiation dose averaging 1 mSv, and a test duration of less than 2 h.
UNLABELLED: Although SPECT myocardial perfusion imaging (MPI) provides valuable information about patients with chest pain, there is growing concern regarding its radiation burden and lengthy duration. New high-efficiency (HE) cameras and stress-first protocols both offer the potential to markedly reduce radiation. No previous study has assessed outcomes and radiation doses of patients undergoing MPI on an HE-SPECT camera using an ultra-low-dose stress-first protocol. METHODS: One hundred patients presenting to the emergency department with chest pain who were candidates for stress-first MPI underwent injection of approximately 185 MBq (5 mCi) of (99m)Tc-tetrofosmin at peak stress, followed by supine and prone imaging on an HE-SPECT camera. Same-day rest imaging was performed on patients with any abnormality on imaging after stress. Radiation effective dose was calculated from administered and residual activities. Patients were contacted 3 mo after discharge, and electronic records were accessed to evaluate the need for reevaluation for chest pain, additional imaging, or cardiac events. RESULTS: Stress-only imaging was performed in 69 patients, for whom radiation effective dose averaged 0.99 mSv and study duration, 117 min. Radiation dose averaged 2.22 mSv over all patients. At 3 mo, 96 patients were free of major adverse cardiac events, repeat hospital chest pain evaluation, and repeat imaging or stress testing. One year after MPI and hospital discharge, all patients were living and without acute coronary syndrome. CONCLUSION: HE-SPECT stress-only imaging can be performed in more than two thirds of chest painpatients without a high pretest probability of a stress perfusion defect, with excellent prognosis, a radiation dose averaging 1 mSv, and a test duration of less than 2 h.
Authors: João V Vitola; Fernando Mut; Erick Alexánderson; Thomas N B Pascual; Mathew Mercuri; Ganesan Karthikeyan; Nathan Better; Madan M Rehani; Ravi Kashyap; Maurizio Dondi; Diana Paez; Andrew J Einstein Journal: J Nucl Cardiol Date: 2016-02-22 Impact factor: 5.952
Authors: Sharmila Dorbala; Karthik Ananthasubramaniam; Ian S Armstrong; Panithaya Chareonthaitawee; E Gordon DePuey; Andrew J Einstein; Robert J Gropler; Thomas A Holly; John J Mahmarian; Mi-Ae Park; Donna M Polk; Raymond Russell; Piotr J Slomka; Randall C Thompson; R Glenn Wells Journal: J Nucl Cardiol Date: 2018-10 Impact factor: 5.952
Authors: Marvin Grossmann; Andreas A Giannopoulos; Fabiola A Bechtiger; Michael Messerli; Moritz Schwyzer; Dominik C Benz; Ken Kudura; Catherine Gebhard; Christoph Gräni; Aju P Pazhenkottil; Philipp A Kaufmann; Ronny R Buechel Journal: J Nucl Cardiol Date: 2018-06-19 Impact factor: 5.952
Authors: Brian G Abbott; James A Case; Sharmila Dorbala; Andrew J Einstein; James R Galt; Robert Pagnanelli; Renée P Bullock-Palmer; Prem Soman; R Glenn Wells Journal: J Nucl Cardiol Date: 2018-10 Impact factor: 5.952