Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables.

Abstract

To evaluate the usefulness of multiple measures from rest and exercise radionuclide angiography (RNA) in predicting cardiovascular death and cardiovascular events (death or nonfatal myocardial infarction) and to assess the prognostic usefulness of the RNA relative to clinical and catheterization data, we studied 571 stable patients with symptomatic coronary artery disease who had upright rest/exercise first-pass RNA within 3 months of catheterization and were medically treated. With a median follow-up of 5.4 years, 90 patients have died from cardiovascular causes, and 147 patients have either died or suffered a nonfatal myocardial infarction. Using the Cox regression model and a preselected group of RNA variables, the most important RNA predictor of mortality was exercise ejection fraction (X2=81, p<0.00001).Neither rest ejection fraction nor the change in ejection fraction from rest to exercise contributed additional predictive information. Two other RNA study variables, the change in heart rate from rest to exercise and rest end-diastolic volume index, did contribute additional prognostic information to the exercise ejection fraction (X2=23, p<0.0001). Compared with noninvasive clinical data (history, physical examination, electrocardiogram, and chest radiograph), RNA variables were considerably more predictive of mortality (X2=71 [

Prognostication in 3-Vessel Coronary Artery Disease Based on Left Ventricular Ejection Fraction During Exercise

“…Our results are consistent with previous reports of prognostic value of the LV exercise response (⌬LVEF 1,6 or absolute exercise LVEF 3 ) in this population 1,3,6 and also among medically treated patients with 1-or 2-vessel CAD and LV dysfunction at rest 32,33 and those not stratified for CAD severity. [2][3][4][5] Most previous studies of 3-vessel disease have dichotomized patients, 1,6,7,32,33 although some also analyzed exercise LVEF as a continuous variable; the majority demonstrated that those with ischemia have poorer outcomes than those without. 1,6,7,32 Our results confirm these findings by demonstrating a direct relation between the magnitude of LVEF exercise response and likelihood of cardiac events, including cardiac death.…”

“…The latter grouping ("expanded medical treatment") enabled confirmation of results from the smaller medicaltreatment-only group and increased statistical power for evaluation of relative prognostic efficiency of different descriptors during nonsurgical follow-up. As in earlier studies, 3,21,22 3 months was selected as the minimum initial period of medical therapy after radionuclide testing.…”

“…When the Relation of baseline ischemia severity to CABG benefit (combined early and late CABG subgroups). P value reflects differences among cardiac event hazard ratios (H/R) (death or MI) derived from non-CABG vs CABG patients, stratified according to 3 postoperative experience of patients with intercurrent events was included in analysis, the advantage of early operation was even more pronounced (Pϭ0.02 for cardiac death; Pϭ0.04 for cardiac events).…”

“…[1][2][3][4][5] However, few studies have assessed the predictive value of exercise LVEF among patients with disease specifically involving all 3 major coronary systems, 1,3,6 -8 and none has examined the independent prognostic value of change (⌬) in LVEF with exercise in this population. Moreover, the relative effects of CABG and of nonsurgical therapy on long-term outcome among subpopulations with equivalent pretherapy LVEF exercise responses are poorly understood, precluding optimal application of test results in patient management.…”

Evaluation of left ventricular function: does the imaging technique matter?

“…This is not without reason. Left ventricular ejection fraction has proven to be an important predictor of mortality in patients with heart failure and after myocardial infarction [1,2]. It is also frequently used to monitor left ventricular remodelling after myocardial infarction and to select patients for ICD therapy and biventricular pacing [3,4].…”