Keiichiro Kuronuma1,2, Robert J H Miller1,3, Yuka Otaki1, Serge D Van Kriekinge1, Marcio A Diniz1, Tali Sharir4, Lien-Hsin Hu1,5, Heidi Gransar1, Joanna X Liang1, Tejas Parekh1, Paul B Kavanagh1, Andrew J Einstein6, Mathews B Fish7, Terrence D Ruddy8, Philipp A Kaufmann9, Albert J Sinusas10, Edward J Miller10, Timothy M Bateman11, Sharmila Dorbala12, Marcelo Di Carli12, Balaji K Tamarappoo1, Damini Dey1, Daniel S Berman1, Piotr J Slomka1. 1. Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA (K.K., R.J.H.M., Y.O., S.D.V.K., M.A.D., L.-H.H., H.G., J.X.L., T.P., P.B.K. B.K.T., D.D., D.S.B., P.J.S.). 2. Department of Cardiology, Nihon University, Tokyo, Japan (K.K.). 3. Department of Cardiac Sciences, University of Calgary, Alberta, Canada (R.J.H.M.). 4. Department of Nuclear Cardiology, Assuta Medical Centers, Tel Aviv, and Ben Gurion University of the Negev, Beer Sheba, Israel (T.S.). 5. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taiwan (L.-H.H.). 6. Division of Cardiology, Departments of Medicine and of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital (A.J.E.). 7. Oregon Heart and Vascular Institute, Sacred Heart Medical Center, Springfield (M.B.F.). 8. Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (T.D.R.). 9. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Switzerland (P.A.K.). 10. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A.J.S., E.J.M.). 11. Cardiovascular Imaging Technologies LLC, Kansas City, MO (T.M.B.). 12. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.D., M.D.C.).
Abstract
BACKGROUND: Phase analysis of single-photon emission computed tomography myocardial perfusion imaging provides dyssynchrony information which correlates well with assessments by echocardiography, but the independent prognostic significance is not well defined. This study assessed the independent prognostic value of single-photon emission computed tomography-myocardial perfusion imaging phase analysis in the largest multinational registry to date across all modalities. METHODS: From the REFINE SPECT (Registry of Fast Myocardial Perfusion Imaging With Next Generation SPECT), a total of 19 210 patients were included (mean age 63.8±12.0 years and 56% males). Poststress total perfusion deficit, left ventricular ejection fraction, and phase variables (phase entropy, bandwidth, and SD) were obtained automatically. Cox proportional hazards analyses were performed to assess associations with major adverse cardiac events (MACE). RESULTS: During a follow-up of 4.5±1.7 years, 2673 (13.9%) patients experienced MACE. Annualized MACE rates increased with phase variables and were ≈4-fold higher between the second and highest decile group for entropy (1.7% versus 6.7%). Optimal phase variable cutoff values stratified MACE risk in patients with normal and abnormal total perfusion deficit and left ventricular ejection fraction. Only entropy was independently associated with MACE. The addition of phase entropy significantly improved the discriminatory power for MACE prediction when added to the model with total perfusion deficit and left ventricular ejection fraction (P<0.0001). CONCLUSIONS: In a largest to date imaging study, widely representative, international cohort, phase variables were independently associated with MACE and improved risk stratification for MACE beyond the prediction by perfusion and left ventricular ejection fraction assessment alone. Phase analysis can be obtained fully automatically, without additional radiation exposure or cost to improve MACE risk prediction and, therefore, should be routinely reported for single-photon emission computed tomography-myocardial perfusion imaging studies.
BACKGROUND: Phase analysis of single-photon emission computed tomography myocardial perfusion imaging provides dyssynchrony information which correlates well with assessments by echocardiography, but the independent prognostic significance is not well defined. This study assessed the independent prognostic value of single-photon emission computed tomography-myocardial perfusion imaging phase analysis in the largest multinational registry to date across all modalities. METHODS: From the REFINE SPECT (Registry of Fast Myocardial Perfusion Imaging With Next Generation SPECT), a total of 19 210 patients were included (mean age 63.8±12.0 years and 56% males). Poststress total perfusion deficit, left ventricular ejection fraction, and phase variables (phase entropy, bandwidth, and SD) were obtained automatically. Cox proportional hazards analyses were performed to assess associations with major adverse cardiac events (MACE). RESULTS: During a follow-up of 4.5±1.7 years, 2673 (13.9%) patients experienced MACE. Annualized MACE rates increased with phase variables and were ≈4-fold higher between the second and highest decile group for entropy (1.7% versus 6.7%). Optimal phase variable cutoff values stratified MACE risk in patients with normal and abnormal total perfusion deficit and left ventricular ejection fraction. Only entropy was independently associated with MACE. The addition of phase entropy significantly improved the discriminatory power for MACE prediction when added to the model with total perfusion deficit and left ventricular ejection fraction (P<0.0001). CONCLUSIONS: In a largest to date imaging study, widely representative, international cohort, phase variables were independently associated with MACE and improved risk stratification for MACE beyond the prediction by perfusion and left ventricular ejection fraction assessment alone. Phase analysis can be obtained fully automatically, without additional radiation exposure or cost to improve MACE risk prediction and, therefore, should be routinely reported for single-photon emission computed tomography-myocardial perfusion imaging studies.
Authors: Subodh B Joshi; Ali K Salah; Dorinna D Mendoza; Steven A Goldstein; Anthon R Fuisz; Joseph Lindsay Journal: Am J Cardiol Date: 2008-11-07 Impact factor: 2.778
Authors: Ji Chen; Ernest V Garcia; Russell D Folks; C David Cooke; Tracy L Faber; E Lindsey Tauxe; Ami E Iskandrian Journal: J Nucl Cardiol Date: 2005 Nov-Dec Impact factor: 5.952
Authors: Yuka Otaki; Julian Betancur; Tali Sharir; Lien-Hsin Hu; Heidi Gransar; Joanna X Liang; Peyman N Azadani; Andrew J Einstein; Mathews B Fish; Terrence D Ruddy; Philipp A Kaufmann; Albert J Sinusas; Edward J Miller; Timothy M Bateman; Sharmila Dorbala; Marcelo Di Carli; Balaji K Tamarappoo; Guido Germano; Damini Dey; Daniel S Berman; Piotr J Slomka Journal: JACC Cardiovasc Imaging Date: 2019-06-12
Authors: Robert J H Miller; Lien-Hsin Hu; Heidi Gransar; Julian Betancur; Evann Eisenberg; Yuka Otaki; Tali Sharir; Mathews B Fish; Terrence D Ruddy; Sharmila Dorbala; Marcelo Di Carli; Andrew J Einstein; Philipp A Kaufmann; Albert J Sinusas; Edward J Miller; Timothy Bateman; Guido Germano; Balaji K Tamarappoo; Damini Dey; Daniel S Berman; Piotr J Slomka Journal: Eur Heart J Cardiovasc Imaging Date: 2020-05-01 Impact factor: 6.875
Authors: Christopher Uebleis; Stefan Hellweger; Rüdiger Paul Laubender; Alexander Becker; Hae-Young Sohn; Sebastian Lehner; Alexander Haug; Peter Bartenstein; Paul Cumming; Serge D Van Kriekinge; Piotr J Slomka; Marcus Hacker Journal: Eur J Nucl Med Mol Imaging Date: 2012-07-03 Impact factor: 9.236