The noninvasive prediction of cardiac mortality in men and women with known or suspected coronary artery disease

Marwick, Thomas H.; Shaw, Leslee J.; Lauer, Michael S.; Kesler, Karen; Hachamovitch, Rory; Heller, Gary V.; Travin, Mark I.; Borges-Neto, S.; Berman, Daniel S.; Miller, D. Douglas

doi:10.1016/s0002-9343(98)00388-x

Cited by 111 publications

(72 citation statements)

References 29 publications

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“…Indeed, the same approach has been used in multicenter nuclear cardiology studies. 24 It is hoped that the development of a quantitative echocardiographic approach may facilitate a subtler means of assessing disease extent in the future. SSS indicates summed stress score (total extent of abnormal segments after exercise).…”

Section: Limitations Of the Studymentioning

confidence: 99%

Prediction of Mortality by Exercise Echocardiography

et al. 2001

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Background-In studies generally involving short follow-up, exercise echocardiography has been shown to predict composite end points. We sought to study the prediction of mortality with this test and to devise a strategy for combination with standard exercise testing. Methods and Results-Clinical, exercise testing, and echocardiographic data were collected in 5375 patients (aged 54Ϯ14 years, 3880 men) undergoing exercise echocardiography. The Duke treadmill score was derived from the results of treadmill exercise testing. Resting left ventricular (LV) function and the presence and severity of ischemia were interpreted by expert observers. Follow-up at 10.6 years (mean 5.5Ϯ1.9 years) was complete in 5211 patients (97%

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Section: Limitations Of the Studymentioning

confidence: 99%

Prediction of Mortality by Exercise Echocardiography

et al. 2001

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“…(56) When an MPI is found to be abnormal, the risk for hard events is related to the severity of the abnormality; the greater the affected area, the higher the risk. (51,(57)(58)(59)(60)(61)(62)(63)(64)(65)(66) Hachamovitch et al found that patients with a mildly abnormal scan were at intermediate risk for myocardial infarction (2.7%) but low risk for cardiac death (0.8%). (60) If the patients had to undergo pharmacological testing for any reason, or are elderly, have previous history of CAD, diabetes mellitus or atrial fi brillation, even with a mildly abnormal scan, the risk is increased.…”

Section: Discussionmentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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Value of nuclear cardiology for the diagnosis and risk stratifi cation of coronary artery disease 106 INTRODUCTIONNuclear cardiology has undergone an outstanding growth during the last 25 years.With technical improvements and new radiopharmaceuticals, higher sensitivity and specifi city of myocardial perfusion imaging (MPI) scans has been achieved for detection and evaluation of ischemic heart disease.MPI is performed with the administration of radiopharmaceuticals which are taken up by the myocardial cells. Different radiotracers can be used, such as: 99m Tc- Sestamibi, 99m Tc-Tetrofosmin, etc.The investigation is performed at rest and stress, providing semiquantitative information on areas of myocardial infarction and ischemia.Beller et al. showed in the "anginal cascade"(1) that, with increasing stress time and myocardial oxygen demand, ischemic ST depression and anginal symptoms appear after fl ow heterogeneity, regional myocardial dysfunction, signifi cant perfusion defects and global left ventricular dysfunction. This accounts for the increased sensitivity, specifi city and accuracy of MPI over symptoms and stress ECG in the diagnosis and follow-up of coronary artery disease.It has developed into one of the most contributory fi elds in clinical decision making for the detection and risk stratifi cation in patients with suspected and known coronary artery disease. USE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE CLINICAL SETTINGMyocardial perfusion SPECT (single photon emission computed tomography) is a widely utilized noninvasive imaging modality for the diagnosis and management of ischemic heart disease. This modality allows a three-dimensional assessment and quantitation of the myocardium and functional assessment through ECG-gating of the perfusion images. Vol. 5, No. 3, 2008 There are several indications for the use of myocardial perfusion SPECT, whether it is for a patient who is not known to have coronary artery disease and the aim is confi rm or rule out the diagnosis, or in the patient with known ischemic heart disease, whether symptomatic or not, for risk-stratifi cation (Table 1). Indications for myocardial perfusion scintigraphy If the patient does not have diagnosis of CADTo exclude or diagnose CAD in patients with suspected CAD As a screening test in those with intermediate or high risk of CAD, e.g. familial hyperlipidemia, type II diabetes mellitus, family history of CAD, and those with atypical symptoms of ischemic heart disease (IHD). In patients with high pretest likelihood for CAD, MPI is mainly useful for risk stratifi cation purposes.In patients with non-diagnostic electrocardiography (ECG), at rest or post-stress. While there are many causes for an abnormal baseline ECG (Table 2), STRESS-ECG is frequently not conclusive. (range 17 to 100).Patients who are at risk of developing peri or postoperative cardiovascular events, i.e. peripheral vascular disease, aortic aneurysm, and the elderly.Acute chest pain -diagnosis of CAD.LBBB can induce perfusion defect in the basal ante...

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“…Because of their lower work capacity on exercise tests (on average 5-7 min) as a result of premature peripheral fatigue, it is difficult to provoke myocardial ischemia [36]. Women who exercise less than 5 metabolic equivalents (METs) are at an increased risk for death [37].…”

Section: Electrocardiographymentioning

confidence: 99%

“…Myocardial perfusion imaging has powerful predictive value with regard to the development of subsequent cardiac death or MI or the need for coronary revascularization [48][49][50], regardless of sex [36]. Prognosis worsens commensurate with the number of vascular territories involved, with 3-year survival rates ranging from 99% for women without ischemia to 85% in women who had three-vessel ischemia [36].…”

Section: Myocardial Perfusionmentioning

confidence: 99%