The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography

Metz, Louise D.; Beattie, M. A.; Hom, Robert A.; Redberg, Rita F.; Grady, Deborah; Fleischmann, Kirsten E.

doi:10.1016/j.jacc.2006.08.048

Cited by 428 publications

(267 citation statements)

References 161 publications

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“…21 Although an abnormal stress echocardiogram correlates with a high cardiac event rate in women, a recent meta-analysis comparing dobutamine stress echocardiography to exercise single photon emission computed tomography (CT) (SPECT) MPI revealed a yearly rate of 0.75% of cardiovascular death and MI in the setting of a low-risk dobutamine echocardiogram compared with 0.3% per year in low-risk stress MPI. 28 The authors concluded that stress echocardiography may underestimate risk in women with less advanced CAD because in the ischemic cascade, perfusion abnormalities detected by SPECT MPI precede the wall-motion abnormalities detected by stress echocardiography. Wall-motion abnormalities often occur in the setting of advanced stenosis and less predictably in myocardium supplied by mild-to-moderate coronary artery stenoses.…”

Section: The Clinical Role Of the Exercise Electrocardiogram: Is It Amentioning

confidence: 99%

“…35, 3, 149-155 (2012) myocardial areas perfused by a less critical stenosis, stress echocardiography may underestimate cardiovascular risk in women with less advanced CAD. 28 The additional imaging information provided by stress echocardiography provides improved diagnostic and prognostic accuracy in women at risk for CAD compared to ETT. 27 In addition, a unique benefit of stress echocardiography for evaluating at-risk women is the absence of radiation exposure compared with other noninvasive imaging techniques (eg, SPECT, cardiac CT, coronary artery calcium [CAC] scoring).…”

Section: The Clinical Role Of the Exercise Electrocardiogram: Is It Amentioning

confidence: 99%

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Noninvasive Diagnostic Techniques for Coronary Disease in Women

Vavas¹,

Hong²,

Rosen³

et al. 2012

Clinical Cardiology

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Significant advances in medical treatment, medical technology, and the focus on sex-specific research have contributed to a reduction in cardiovascular mortality in women. Despite these advances, coronary artery disease (CAD) is the leading cause of cardiovascular death of women in the Western world. In the past 2 decades, the focused research on women at risk for CAD has helped to clarify our understanding of some of the sex-specific factors that are important in the detection of CAD. In women, the detection and evaluation of physiologically significant CAD can be challenging. Many of the traditional tests that are designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients, who have a greater burden of symptoms, higher atherosclerotic burden, and lower prevalence of obstructive coronary disease. In this article, we review the available evidence on the role of contemporary noninvasive diagnostic techniques in the evaluation of women with symptoms of CAD.

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Section: The Clinical Role Of the Exercise Electrocardiogram: Is It Amentioning

confidence: 99%

Section: The Clinical Role Of the Exercise Electrocardiogram: Is It Amentioning

confidence: 99%

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Vavas¹,

Hong²,

Rosen³

et al. 2012

Clinical Cardiology

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“…Prognostic information is useful in cardiac risk stratification and subsequent clinical management. Also, accurate risk stratification has become increasingly important in optimizing patient outcomes and containing rapidly escalating medical care costs [9]. Similarly, it is important to assess the prognostic value of negative stress CMR from possibility of decreasing unnecessary additional tests and interventions.…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

Iwata

Nakagawa

Ogasawara

2014

Journal of Computer Assisted Tomography

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None of the authors have any conflicts of interest associated with this study. Abstract ObjectivesThe purpose of our study was to determine the prognostic value of normal stress cardiovascular MRI (CMR) by a systematic literature review and meta-analysis. MethodsA comprehensive literature search of published studies through November 2011 in MEDLINE database and Cochrane Library, regarding prognostic value of stress CMR in patients with known or suspected coronary artery disease (CAD), was performed. ResultsUltimately, we identified 11 studies. The summary relative risk ratio for major adverse cardiac events (MACE) was 0.50 (95% confidence interval (CI): 0.44 to 0.58) for normal cine CMR and 0.09 (95% CI: 0.02 to 0.35) for normal perfusion CMR. The summary relative risk ratio for hard cardiac events was 0.36 (95% CI: 0.16 to 0.8) for normal cine CMR and 0.22 (95% CI: 0.07 to 0.66) for normal perfusion CMR. ConclusionNormal stress CMR for patients known or suspected of having CAD has good prognostic value in predicting cardiac events.

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“…This is not only true for patients with greater extent, severity, and reversibility of MPS abnormalities, but also for those with normal MPS findings. 1 The salutatory prognosis of those with a normal MPS test has lead to the implication of a ''warranty period'' following a normal SPECT stress test.While tempting to generalize this ''warranty period'' to all patients undergoing MPS, rates of freedom from adverse cardiac events differ significantly for patients with normal exercise MPS as compared to patients with normal pharmacological MPS. 2 The reasons for these observed differences based on the method of hyperemia induction may seem intuitive; patients who undergo pharmacological MPS tend toward older age, greater numbers of CAD risk factors, increased non-cardiac co-morbidities and reduced functional status, a known powerful predictor of mortality.…”

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The relative nature of a “normal” myocardial perfusion SPECT

Min

Bell

2010

Journal of Nuclear Cardiology

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See related article, pp. 999-1008The farther backward you can look, the farther forward you can see.Winston ChurchillWith an array of non-invasive imaging modalities available to diagnose and risk stratify individuals with suspected coronary artery disease (CAD), myocardial perfusion SPECT (MPS) has distinguished itself from others owing to its wealth of prognostic data. This is not only true for patients with greater extent, severity, and reversibility of MPS abnormalities, but also for those with normal MPS findings. 1 The salutatory prognosis of those with a normal MPS test has lead to the implication of a ''warranty period'' following a normal SPECT stress test.While tempting to generalize this ''warranty period'' to all patients undergoing MPS, rates of freedom from adverse cardiac events differ significantly for patients with normal exercise MPS as compared to patients with normal pharmacological MPS. 2 The reasons for these observed differences based on the method of hyperemia induction may seem intuitive; patients who undergo pharmacological MPS tend toward older age, greater numbers of CAD risk factors, increased non-cardiac co-morbidities and reduced functional status, a known powerful predictor of mortality. 3 Nevertheless, because prior studies comparing those undergoing exercise vs pharmacological MPS have not accounted for these clinical differences, it remains unknown whether the prognostic ability of a normal MPS also differs for individuals who can against cannot exercise. To address this question, Rozanski et al 4 undertook an important study evaluating the prognostic differences between normal exercise and normal pharmacological MPS-as defined by a summed stress score B3-among patients with similar clinical profiles.The authors followed 6,069 patients without known CAD for 10.2 ± 1.7 years for rates of all-cause mortality. By propensity score analysis accounting for age, gender, angina typicality, CAD risk factors, medications, and baseline findings at the time of MPS testing (including heart rate, blood pressure, and presence of left ventricular hypertrophy), the authors further compared 1,125 patients with normal exercise MPS (defined by summed stress score B 3) matched to 1,125 patients with normal pharmacological MPS for long-term all-cause mortality, as well as short-term 2.6 ± 2.1 years cardiac death and non-fatal myocardial infarction.Within propensity-matched groups manifesting normal MPS findings, individuals undergoing pharmacological MPS still experienced an annualized mortality rate that was almost twofold that of their exercising counterparts (3.9% vs 1.6%, P \ .0001), a relationship consistently observed across all age groups and independent of smoking status, diabetic state, body mass index, presence of left ventricular hypertrophy, or history of peripheral vascular disease. Even more divergent differences were observed for short-term cardiac outcomes between propensity-matched patients manifesting normal exercise vs normal pharmacological MPS, with a nearly sixfold higher annua...

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The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography

Abstract: Both exercise MPI and exercise echocardiography have high NPVs for primary and secondary cardiac events. The prognostic utility of both modalities is similar for both men and women.

Cited by 428 publications

References 161 publications

Noninvasive Diagnostic Techniques for Coronary Disease in Women

Noninvasive Diagnostic Techniques for Coronary Disease in Women

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

The relative nature of a “normal” myocardial perfusion SPECT

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