Robert J H Miller1, Lien-Hsin Hu1,2, Heidi Gransar1, Julian Betancur1, Evann Eisenberg1, Yuka Otaki1, Tali Sharir3, Mathews B Fish4, Terrence D Ruddy5, Sharmila Dorbala6, Marcelo Di Carli6, Andrew J Einstein7,8, Philipp A Kaufmann9, Albert J Sinusas10, Edward J Miller10, Timothy Bateman11, Guido Germano1, Balaji K Tamarappoo1, Damini Dey1, Daniel S Berman1, Piotr J Slomka1. 1. Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. 2. Department of Nuclear Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Taipei, Taiwan. 3. Department of Nuclear Cardiology, Assuta Medical Center, HaBarzel St 20, Tel Aviv, Israel. 4. Department of Nuclear Medicine, Oregon Heart and Vascular Institute, Sacred Heart Medical Center, 3333 Riverbend Dr, Springfield, OR 97477, USA. 5. Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada. 6. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. 7. Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA. 8. Department of Radiology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA. 9. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. 10. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA. 11. Cardiovascular Imaging Technologies LLC, 4320 Wornall Rd, Kansas City, MO 64111, USA.
Abstract
AIMS: Ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is strongly associated with cardiovascular risk. Transient ischaemic dilation (TID) and post-stress wall motion abnormalities (WMA) are non-perfusion markers of ischaemia with incremental prognostic utility. Using a large, multicentre SPECT MPI registry, we assessed the degree to which these features increased the risk of major adverse cardiovascular events (MACE) in patients with less than moderate ischaemia. METHODS AND RESULTS: Ischaemia was quantified with total perfusion deficit using semiautomated software and classified as: none (<1%), minimal (1 to <5%), mild (5 to <10%), moderate (10 to <15%), and severe (≥15%). Univariable and multivariable Cox proportional hazard analyses were used to assess associations between high-risk imaging features and MACE. We included 16 578 patients, mean age 64.2 and median follow-up 4.7 years. During follow-up, 1842 patients experienced at least one event. Patients with mild ischaemia and TID were more likely to experience MACE compared with patients without TID [adjusted hazard ratio (HR) 1.42, P = 0.023], with outcomes not significantly different from patients with moderate ischaemia without other high-risk features (unadjusted HR 1.15, P = 0.556). There were similar findings in patients with post-stress WMA. However, in multivariable analysis of patients with mild ischaemia, TID (adjusted HR 1.50, P = 0.037), but not WMA, was independently associated with increased MACE. CONCLUSION: In patients with mild ischaemia, TID or post-stress WMA identify groups of patients with outcomes similar to patients with moderate ischaemia. Whether these combinations identify patients who may derive benefit from revascularization deserves further investigation. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Ischaemia on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is strongly associated with cardiovascular risk. Transient ischaemic dilation (TID) and post-stress wall motion abnormalities (WMA) are non-perfusion markers of ischaemia with incremental prognostic utility. Using a large, multicentre SPECT MPI registry, we assessed the degree to which these features increased the risk of major adverse cardiovascular events (MACE) in patients with less than moderate ischaemia. METHODS AND RESULTS:Ischaemia was quantified with total perfusion deficit using semiautomated software and classified as: none (<1%), minimal (1 to <5%), mild (5 to <10%), moderate (10 to <15%), and severe (≥15%). Univariable and multivariable Cox proportional hazard analyses were used to assess associations between high-risk imaging features and MACE. We included 16 578 patients, mean age 64.2 and median follow-up 4.7 years. During follow-up, 1842 patients experienced at least one event. Patients with mild ischaemia and TID were more likely to experience MACE compared with patients without TID [adjusted hazard ratio (HR) 1.42, P = 0.023], with outcomes not significantly different from patients with moderate ischaemia without other high-risk features (unadjusted HR 1.15, P = 0.556). There were similar findings in patients with post-stress WMA. However, in multivariable analysis of patients with mild ischaemia, TID (adjusted HR 1.50, P = 0.037), but not WMA, was independently associated with increased MACE. CONCLUSION: In patients with mild ischaemia, TID or post-stress WMA identify groups of patients with outcomes similar to patients with moderate ischaemia. Whether these combinations identify patients who may derive benefit from revascularization deserves further investigation. Published on behalf of the European Society of Cardiology. All rights reserved.
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