Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity
Autor: | Paolo Bruzzi, Cecilia Marini, Roberta Assante, Selene Capitanio, Francesco Fiz, Wanda Acampa, Emilia Zampella, Gianmario Sambuceti, Valeria Cantoni, Alberto Cuocolo, Bassam Dib, Matteo Bauckneht, Stefania Daniele |
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Přispěvatelé: | Marini, C, Acampa, Wanda, Bauckneht, M, Daniele, S, Capitanio, S, Cantoni, Valeria, Fiz, F, Zampella, Emilia, Dib, B, Assante, Roberta, Bruzzi, P, Sambuceti, G, Cuocolo, Alberto |
Rok vydání: | 2014 |
Předmět: |
Male
medicine.medical_specialty Ischemia Cardiology Myocardial Infarction Ischaemia Coronary artery disease Imaging Myocardial perfusion imaging Predictive Value of Tests Internal medicine Medicine Humans Radiology Nuclear Medicine and imaging Myocardial infarction cardiovascular diseases Maximal rate Nuclear Medicine Aged Exercise Tolerance medicine.diagnostic_test business.industry Myocardial Perfusion Imaging General Medicine Arteriosclerosis Middle Aged medicine.disease Prognosis Penetrance Exercise Test Female business Mace Algorithms |
Zdroj: | European journal of nuclear medicine and molecular imaging 42 (2015): 750–760. doi:10.1007/s00259-014-2963-8 info:cnr-pdr/source/autori:Marini C, Acampa W, Bauckneht M, Daniele S, Capitanio S, Cantoni V, Fiz F, Zampella E, Dib B, Assante R, Bruzzi P, Sambuceti G, Cuocolo A./titolo:Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity/doi:10.1007%2Fs00259-014-2963-8/rivista:European journal of nuclear medicine and molecular imaging (Print)/anno:2015/pagina_da:750/pagina_a:760/intervallo_pagine:750–760/volume:42 (2014). doi:10.1007/s00259-014-2963-8 info:cnr-pdr/source/autori:Marini C.; Acampa W.; Bauckneht M.; Daniele S.; Capitanio S.; Cantoni V.; Fiz F.; Zampella E.; Dib B.; Assante R.; Bruzzi P.; Sambuceti G.; Cuocolo A./titolo:Added prognostic value of ischaemic threshold in radionuclide myocardial perfusion imaging: a common-sense integration of exercise tolerance and ischaemia severity/doi:10.1007%2Fs00259-014-2963-8/rivista:European journal of nuclear medicine and molecular imaging (Print)/anno:2014/pagina_da:/pagina_a:/intervallo_pagine:/volume |
ISSN: | 1619-7089 |
Popis: | Purpose: Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD).,Methods and results: We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2-4) in 180, moderate (SDS 5-7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information.,Conclusion: Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD. |
Databáze: | OpenAIRE |
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