Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging

Chang, Su Min; Nabi, Faisal; Xu, Jiaqiong; Raza, Umara; Mahmarian, John J.

doi:10.1016/j.jacc.2009.09.022

Cited by 203 publications

(150 citation statements)

References 18 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…This study provides further confirmation that AC is an important requirement for the successful implementation of a stress-only imaging protocol in routine clinical practice. Our findings as well as those from previous studies 1,[5][6][7] demonstrate that normal AC stress-only imaging is associated with a very low incidence of short-term cardiac events ([11,722 patients in aggregate, including 1,247 from this study, Table 6) and suggests that such patients do not need to undergo additional rest imaging.…”

Section: Discussionsupporting

confidence: 86%

“…1,[5][6][7] This report emphasizes two important additional findings: first, the inherent value of AC which results in very few patients requiring additional rest imaging and second, the confidence of physicians in that if the stress image is abnormal, clinical decisions often can be made without an additional rest scan (high cardiac revascularization rate in patients with abnormal stress-only images). Reducing radiation exposure during imaging studies has been an ongoing issue.…”

Section: Discussionmentioning

confidence: 85%

“…1,2 In order for this strategy to be successful, rest imaging should be minimized, and the results (either normal or abnormal) carry appropriate risk of future cardiac events. Previous stress-only studies without AC have suggested the necessity for rest imaging to be as high as 50%-78%, rendering the procedure inefficient.…”

Section: Discussionmentioning

confidence: 99%

“…Stress-only imaging in selected patients has emerged as an alternative means of reducing both procedure time and radiation exposure. 1,2 With this approach, the necessity for a comparative rest study is dependent upon the presence of an abnormal finding on stress imaging which frequently is due to attenuation artifact and has been estimated to occur in 50%-78% of studies. 3 The use of attenuation correction (AC) with SPECT has been shown to significantly reduce false positive studies for both rest-stress and stress-only imaging.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 The value of stress-only imaging with normal results has been confirmed by outcomes data from previous studies. 1,[5][6][7] While most of these studies utilized AC, there is insufficient information on the impact of this technique with stress-only imaging regarding post-test patient management (necessity for additional rest imaging) and cardiac risk stratification. Accordingly, the purpose of this study was to determine the clinical value of stressonly SPECT imaging with AC in a consecutive series of clinically referred patients with symptoms suggestive of myocardial ischemia.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Mathur

Heller

Bateman

et al. 2013

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Background. In selected patients, stress-only SPECT imaging has been proposed as an alternative to rest-stress SPECT imaging to improve laboratory efficiency and reduce radiation exposure. The impact of attenuation correction (AC) upon interpretation, post-test patient management and cardiac risk stratification in relation to stress-only imaging is not well understood.Objectives. The purpose of this study was to determine the clinical value for laboratory throughput and predicting outcomes of normal and abnormal stress-only SPECT imaging with AC in a consecutive series of clinically referred patients.Methods. A retrospective analysis of 1,383 consecutive patients who were scheduled for stress-only SPECT imaging for symptom assessment of suspected myocardial ischemia was performed. All images had been interpreted and categorized using the standard 17-segment model without AC followed by AC. Follow-up data for 2.1 ± 1.3 years after SPECT imaging for the occurrence of cardiac events (non-fatal MI, cardiac death, and cardiac revascularization) previously collected by routine methods were reviewed.Results. Non-AC SPECT image interpretation revealed that 58% (802/1383) of patients had abnormal stress images. AC image interpretation of the abnormal non-AC images re-classified 83% (666/802) of these as normal. Among patients with abnormal stress images after AC (136/ 1383), 63% (86/136) returned for additional rest scans, while the remaining 37% (50/136) were clinically managed without further rest images. The incidence of cardiac death or non-fatal MI was very low in patients with normal stress-only scans (0.7%).Conclusion. A strategy of stress-only imaging with AC in symptomatic patients is an efficient method which appropriately identifies at risk and low-risk patients yielding a low percentage requiring rest imaging. Clinical decisions can be made based on abnormal stress-only imaging without further rest imaging if clinically appropriate. (J Nucl Cardiol 2013;20:27-37.)

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Mathur

Heller

Bateman

et al. 2013

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

show abstract

Multiple Testing, Cumulative Radiation Dose, and Clinical Indications in Patients Undergoing Myocardial Perfusion Imaging

Einstein

Weiner²,

Bernheim³

et al. 2010

JAMA

153

View full text Add to dashboard Cite

TILIZATION OF MEDICALimaging has grown rapidly in recent years. 1 Along with the benefits patients have received from medical imaging has come an increase in the burden of ionizing radiation associated with many such tests and the attendant potential risks of cancer. The National Council on Radiation Protection and Measurements has estimated that the per capita dose of medical radiation in the United States increased nearly 6-fold from the early 1980s to 2006. 2 This increased medical radiation burden has raised public health concerns, leading to a US Food and Drug Administration initiative to reduce unnecessary radiation exposure from medical imaging, 3 with one of its focuses being nuclear imaging, and discussion in Congress of new legislation to regulate medical radiation. 4 Although much attention has been paid to radiation from computed tomography (CT) scans, 5,6 a recent study demonstrated that the single test with the highest radiation burden, accounting for 22% of cumulative effective dose from medical sources, is myocardial perfusion imaging (MPI). 7 Volume of MPI increased from less than 3 million procedures in the United States in 1990 to 9.3 million in 2002, 8 and it is now estimated to account for more than 10% of the entire cumulative effective dose to the US population from all sources, excluding radiotherapy. 2

show abstract

Radiation Safety in Nuclear Cardiology—Current Knowledge and Practice: Results From the 2011 American Society of Nuclear Cardiology Member Survey

Einstein¹,

Tilkemeier²,

Fazel³

et al. 2013

JAMA Intern Med

View full text Add to dashboard Cite

Normal Stress-Only Versus Standard Stress/Rest Myocardial Perfusion Imaging

Cited by 203 publications

References 18 publications

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Clinical value of stress-only Tc-99m SPECT imaging: Importance of attenuation correction

Multiple Testing, Cumulative Radiation Dose, and Clinical Indications in Patients Undergoing Myocardial Perfusion Imaging

Radiation Safety in Nuclear Cardiology—Current Knowledge and Practice: Results From the 2011 American Society of Nuclear Cardiology Member Survey

Contact Info

Product

Resources

About