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In last years, innovation leads to development of Cadmium Zinc Telluride (CZT) cameras for myocardial perfusion imaging (MPI) which brought better comfort, reduce imaging time and radiation exposure to patients while improve diagnosis performances. Major studies with CZT camera used a single isotope protocol to evaluate the prognostic value though it has been proved the feasibility and efficiency of a dual isotope protocol (rest Thallium-201 / stress Technetium-99m-sestamibi) in little studies including less than 50 patients. The study included patients with normal rest LVEF (>45%) and who had no or minimal perfusion defects (SSS< 4) on a dual isotope MPI following a symptom-limited treadmill test or a pharmacological stress testing. These 1003 patients were followed for 3.04 years. The main endpoint was the occurrence a hard-cardiac event (cardiac death, nonfatal myocardial infarction or unexpected coronary revascularization). 562 (56%) patients were males, the mean age was 64 years old (yo). 199 (20%) had a previous history of personal coronary artery disease (CAD). 319 (32%) were smoking, 467 (47%) had a high blood cholesterol level and 615 (61%) high blood pressure. 433 (43%) were diabetic. In most of the cases, MPI was performed for research of a silent ischemia (593, 59%). The majority of the patient (591, 59%) had a pharmacologic stress. The mean rest LVEF was 63 ± 8%, 785 (78%) had a SSS at 0 or 1 and 218 (22%) had a SSS at 2 or 3. 55 hard cardiac events occurred (22 cardiovascular deaths, 13 nonfatal myocardial infarctions and 20 unexpected coronary revascularizations). Statistically significative differences with the free events group were observed: patients with cardiac events were older (73 ± 10 yo; p < 0.001), had more history of personal CAD (p = 0.01), more dyslipidemia (p = 0.04) and their SSS was more often at 2-3 (p = 0.01). However, having an atypical chest pain as indication of the exam (p= 0.006) or being able of making an exercise stress (p < 0.001) test was protector. In multivariable analysis, age (HR 1.08 [1.05; 1.11], p< 0.001), previous CAD (HR 2.05 [1.16 -3.61], P = 0.01) and SSS at 2-3 (HR 1.88 [1.07; 3.28] , p = 0.027) were predictor of cardiac events.The use of a dual isotope protocol on a CZT camera provides prognostic information, comparable to single-isotope protocols on conventional CZT camera, while reducing imaging time but it also underlines a subgroup of patients with SSS at 2 or 3 who have a poorest prognosis than the overs.; Le développement des caméras au Cadmium Zinc Telluride (CZT-SPECT) pour l’imagerie myocardique de perfusion (MPI) a permis de diminuer l’irradiation et ainsi de développer l’utilisation de protocole double isotope Thallium 201 à l’effort / Technétium 99m Sestamibi au repos (DI-HS-MPI). Ainsi en utilisant le meilleur traceur SPECT au stress cumulé aux performances de la CZT-SPECT, il est licite de vérifier la valeur pronostique d’une CZT-SPECT dite normale avec summed stress score (SSS) 45%) mesurée en scintigraphie et une recherche d’ischémie par DI-HS-MPI avec SSS |
