Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

Abstract

BackgroundCardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined.ObjectiveTo verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group.MethodsThis was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05.ResultsOf the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5%) had non-fatal myocardial infarction and six individuals (0.7%) died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036) and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0.043).ConclusionThe occurrence of major cardiac events in 8 years was small. Patients with fibrosis at MS had more major events, whereas patients with normal MS result had fewer major cardiac events, with higher survival.

Effectiveness of Cardiac Scintigraphy and Standard Eco-Cardiograph in the Detection and Evaluation of Cardiac Disorders, Including Ischemic Heart Diseases

“…Al-S. M. Bafaraj though any comment could not be made on the ability of scintigraphy in the detection of asymptomatic patients in the present study, recent evidence showed that myocardial scintigraphy could also detect asymptomatic ischemia prevailing in early CAD family history and patients with erectile dysfunction, chronic renal failure, and type 2 diabetes. For such case detection, the recommendation to go through scintigraphy investigation is not so popular to date (Supplementary Tables S4-S6) [24].…”

Hospital Pharmacological Treatment of Acute Myocardial Infarction with st Supra: Sus x Private

“…Due to the incidence of Coronary Arterial Death (CAD), it is high in the whole world, and not Brazil, it is the second main cause of death in Brazil and you have indicated that 97 thousand deaths, due to ischemic heart disease, in a year, responsible for 210,046 hospital admissions in Brazil and 29% two deaths (99,408 deaths or 55.11 deaths / 100 thousand inhabitants [9] corresponding to 19% of total custody with hospital internment, a sum of R $ 1.9 bilhão [1].…”

Análise crítica dos critérios de uso apropriado da cintilografia de perfusão miocárdica na investigação não invasiva de isquemia em pacientes assintomáticos de alto risco cardiovascular

“…A taxa de exames normais foi de 58,6%. A ocorrência de eventos foi pequena e predominante nos pacientes com fibrose, enquanto que os pacientes com exame normal tiveram menos eventos e maior sobrevida 32 .…”

“…Além disso, sabemos que é a identificação de fibrose que traz grande valor prognóstico para o método 20,32 . Em nosso estudo não encontramos associação com significância estatística entre isquemia e os graus de recomendação propostos pelos critérios AUC.…”

“…O resultado da avaliação de isquemia evidenciou que 16,1% da população alvo do nosso estudo apresentou isquemia, uma taxa semelhante à de outro estudo realizado em nosso serviço há alguns anos e publicado em 2015, estudo este que, contudo, incluiu também pacientes com sintomas atípicos, como os com dor torácica atípica e dispneia 32 . Esperava-se que nosso estudo apresentasse uma taxa de isquemia inferior àquele, por ter excluído pacientes com sintomas atípicos, o que não ocorreu.…”