Gated SPECT perfusion imaging for the simultaneous assessment of myocardial perfusion and ventricular function in the BARI 2D trial: An initial report from the Nuclear Core Laboratory

Iskandrian, Ami E.; Heo, Jack; Mehta, Deval; Tauxe, E. Lindsey; Yester, Michael V.; Hall, Mary Beth; MacGregor, Joan M.

doi:10.1016/j.nuclcard.2005.10.002

Cited by 20 publications

(9 citation statements)

References 2 publications

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“…5 In brief, diabetic patients enrolled in the BARI 2D trial were recommended a 1-year stress MPS, if clinically feasible. One-year nuclear data was defined as data collected between 6 and 24 months past randomization.…”

Section: Trial Methodsmentioning

confidence: 99%

Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial

Shaw

Cerqueira

Brooks

et al. 2012

Journal of Nuclear Cardiology

133

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Background The Bypass Angioplasty Revascularization Investigation 2 Diabetes trial demonstrated similar long-term clinical effectiveness of revascularization (REV) and intensive medical (MED) therapy. Comparisons of post-intervention ischemic burden have not been explored but are relevant to treatment decisions. This study examined differences in 1-year stress myocardial perfusion SPECT (MPS) abnormalities by randomized treatment. Methods MPS was performed in 1,505 patients at 1-year following randomization. MPS images were analyzed (masked to treatment) by a Nuclear Core Laboratory using a quantitative percent (%) of total, ischemic, and scarred myocardium. Cox proportional hazards models were used to estimate the relationship between MPS variables and trial endpoints. Results At 1-year, nearly all REV patients underwent the assigned procedure; while 16% of those randomized to MED received coronary REV. Patients randomized to REV exhibited fewer stress perfusion abnormalities than MED patients (P < .001). CABG patients had more frequent ischemic and scarred myocardium encumbering ≥5% of the myocardium when compared to those receiving PCI. Patients randomized to MED had more extensive ischemia and the median % of the myocardium with perfusion abnormalities was lower following REV (3% vs 9%, P = .01). A total of 59% of REV patients had no inducible ischemia at 1-year compared to 49% of MED patients (P < .001). Within the CABG stratum, those randomized to MED had the greatest rate of ischemic (P = .032) and scarred (P = .017) perfusion abnormalities. At 1-year, more extensive and severe stress myocardial perfusion abnormalities were associated with higher 5-year rates of death and a combined endpoint of cardiac death or myocardial infarction (MI) rates (11.3%, 8.1%, 6.8%, for ≥10%, 5%-9.9%, and 1-4.9% abnormal myocardium at stress, respectively, P < .001). In adjusted models, selected MPS variables were significantly associated with an increased hazard of cardiac death or MI (hazard ratio = 1.11 per 5% increase in abnormal myocardium at stress, P = .004). Conclusions Patient management strategies that focus on ischemia resolution can be useful to guide the efficacy of near-term therapeutic approaches. A 1-year post-therapeutic intervention myocardial perfusion scan provides important information regarding prognosis in stable CAD patients with diabetes. (J Nucl Cardiol 2012;19:658–69.)

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Section: Trial Methodsmentioning

confidence: 99%

Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial

Shaw

Cerqueira

Brooks

et al. 2012

Journal of Nuclear Cardiology

133

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“…It has the major advantage of being automated and reproducible. 17 Cardiac ischemia and SD in combination portend a worse outcome. Presence of ischemia or scar limits the capacity to recover LV function.…”

Section: Concise Methodsmentioning

confidence: 99%

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

Mattos

Siedlecki

Gaston

et al. 2008

Journal of the American Society of Nephrology

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Individuals waiting for a renal transplant experience excessive cardiovascular mortality, which is not fully explained by the prevalence of ischemic heart disease in this population. Overt heart failure is known to increase the mortality of patients with ESRD, but the impact of lesser degrees of ventricular systolic dysfunction is unknown. For examination of the association between left ventricular ejection fraction (LVEF) and mortality of renal transplant candidates, the records of 2718 patients evaluated for transplantation at one institution were reviewed. During 6355 patient-years (median 27 mo) of follow-up, 681 deaths occurred. Patients with systolic dysfunction (LVEF Յ0.40) had significantly lower survival than those with higher systolic function (median 49 Ϯ 3.1 versus 72 Ϯ 4.0 mo; P Ͻ 0.001) but had similar survival to patients with ischemia (48 Ϯ 2.5 mo). Multivariate modeling showed that those with systolic dysfunction were nearly twice as likely to die as those with normal systolic function, adjusted for risk factors including diabetes, left ventricular hypertrophy, and ischemia (adjusted hazard ratio 1.7; 95% confidence interval 1.43 to 2.07). In addition, a graded, reverse association between LVEF and mortality was identified. In conclusion, systolic dysfunction is strongly associated with mortality, in a graded manner, in renal transplant candidates.

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“…It has the major advantage of being automated and reproducible. In addition to EF, the gated method allows measurement of LV end-diastolic and endsystolic volumes (7). Gated stress (adenosine) and rest SPECT perfusion imaging was performed according to standard methods.…”

Section: Gated Spect Imagingmentioning

confidence: 99%

The Impact of Left Ventricular Systolic Dysfunction on Survival After Renal Transplantation

et al. 2007

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Gated SPECT perfusion imaging for the simultaneous assessment of myocardial perfusion and ventricular function in the BARI 2D trial: An initial report from the Nuclear Core Laboratory

Abstract: This article describes the methodology and the initial experience of the nuclear core laboratory in this large multicenter trial and provides a summary of variables that are available for future analysis by the working group.

Cited by 20 publications

References 2 publications

Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial

Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial

Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant

The Impact of Left Ventricular Systolic Dysfunction on Survival After Renal Transplantation

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