The role of radionuclide myocardial perfusion imaging for asymptomatic individuals

Hendel, Robert C.; Abbott, Brian; Bateman, Timothy M.; Blankstein, Ron; Calnon, Dennis A.; Leppo, Jeffrey A.; Maddahi, Jamshid; Schumaecker, Matthew M.; Shaw, Leslee J.; Ward, R. Parker; Wolinsky, David G.

doi:10.1007/s12350-010-9320-5

Cited by 40 publications

(16 citation statements)

References 129 publications

(118 reference statements)

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“…Recent position statements by the American College of Cardiology/American Heart Association 28 and the American Society of Nuclear Cardiology 29 indicate that myocardial perfusion imaging may be considered in asymptomatic adults with a strong family history of CAD, although there are no prior studies that support this and no guidelines currently exist. Our findings indicate that stress myocardial perfusion imaging in asymptomatic persons with a sibling history of premature CAD further risk stratifies persons in the Framingham intermediate risk category.…”

Section: Discussionmentioning

confidence: 99%

Severity of inducible myocardial ischemia predicts incident acute coronary syndromes in asymptomatic individuals with a family history of premature coronary artery disease

Král

Becker

Vaidya

et al. 2012

Journal of Nuclear Cardiology

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Background Although the severity of inducible ischemia provides incremental prognostic information in persons with known or suspected coronary artery disease (CAD), its significance for predicting long-term CAD outcomes in apparently healthy populations is unknown. This study was designed to evaluate the presence and degree of myocardial ischemia in asymptomatic siblings of persons with premature CAD <60 years of age and to determine its significance for predicting incident acute coronary syndromes (ACS) during follow-up of 5 to 25 years. Methods Siblings (n = 1,287, age 30-59 years, 55% female) were screened for traditional risk factors, underwent exercise treadmill testing with nuclear perfusion imaging, and were followed for the development of ACS (mean follow-up 11.6 ± 5.1 years). The severity of ischemia was assessed by semiquantitative methods using the standard 17-segment model and then categorized by the percent maximal summed stress score as none (0%), minimal (1% to <5%), mild (5% to 10%), moderate (10% to 15%), or severe (≥15%). Results ACS occurred in 132 subjects (10.3%) and included sudden cardiac death (n = 13), acute MI (n = 62), and unstable angina with revascularization (n = 57). The presence of no (88%), minimal (6%), mild (5%), and moderate/severe (1%) ischemia was associated with an ACS incidence of 8.3%, 19.7%, 25.0%, and 38.9%, respectively (P < .0001 for trend). Kaplan-Meier event-free survival analyses by myocardial ischemia severity categories showed that even minimal and mild myocardial ischemia were associated with greater ACS incidence detectable as early as 2 years after baseline. A Cox proportional hazard model, adjusted for risk factors and follow-up time, showed that each 5% increment in the severity of ischemia resulted in a 77% increase in the hazard of incident ACS (P < .001). Conclusion Inducible myocardial ischemia is prevalent in asymptomatic siblings of persons with early onset CAD. Most ischemia is minimal or mild in severity, and although the severity of ischemia is associated with the risk of ACS in a graded fashion, the presence of even minimal and mild perfusion defects predicts worse CAD outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Severity of inducible myocardial ischemia predicts incident acute coronary syndromes in asymptomatic individuals with a family history of premature coronary artery disease

Král

Becker

Vaidya

et al. 2012

Journal of Nuclear Cardiology

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“…High risk asymptomatic patients (e.g., those with abnormal CAC score) may benefit by shortening test time in patients assumed to have normal resting imaging. 17 Perhaps, even patients with only fixed defects on previous studies could become candidates for stress-only imaging.…”

Section: Stress-only Imagingmentioning

confidence: 99%

The future of SPECT MPI: Time and dose reduction

Henzlova

Duvall

2011

Journal of Nuclear Cardiology

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“…Proto se u asymptomatických pacientů s významnými kalcifi kacemi (kalciové skóre > 400 a u vybraných pacientů i v rozmezí 101-400) doporučuje doplnit zátěžové SPECT zobrazení perfuze myokardu. 21 V našem souboru jsme zvýšené kalciové skóre ≥ 101 prokázali u 27 pacientů, žádnou kardiální příhodu jsme však nezaznamenali u 20 z nich, kteří měli současně normální zátěžové zobrazení pomocí SPECT (typický pacient viz obrázek 2). Zbývajících sedm pacientů mělo pomocí SPECT prokázanou ischemii a čtyři z nich podstoupili koronární revaskularizaci (typický pacient viz obrázek 3).…”

Section: Diskuseunclassified

Prognostic value of coronary artery calcium score in combination with cardiac stress sigle-photon emission tomography imaging in an asymptomatic population

Budíková¹,

Kamínek²,

Sovová³

et al. 2011

Cor Vasa

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Cíl: Cílem práce bylo posoudit prognostický význam koronárního kalciového skóre v kombinaci se zátěžovým zobrazením myokardu pomocí jednofotonové emisní tomografi e (SPECT) u asymptomatických rizikových pacientů. Metodika: Byl analyzován soubor 128 pacientů (79 mužů a 49 žen, průměrný věk 54 ± 10 let, 25 s diabetem), kteří prodělali zátěžové gated SPECT vyšetření a současně kvantifi kaci kalciového skóre. Sumační perfuzní zátěžové a rozdílové skóre (SSS, resp. SDS), ejekční frakce (EF) a end-diastolické, resp. end-systolické objemy levé komory (EDV/ESV) byly automaticky stanoveny programem 4D-MSPECT. Závažná kardiální příhoda byla defi nována jako náhlá srdeční smrt nebo nefatální infarkt myokardu (IM), a dále byly evidovány obtíže vyžadující revaskularizaci. Výsledky: Během průměrného sledovacího období 17 ± 9 měsíců jsme evidovali dva nefatální IM a osm revaskularizací. V podskupině 10 pacientů s kardiální příhodou byla v porovnání s pacienty bez příhody horší perfuze (

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The role of radionuclide myocardial perfusion imaging for asymptomatic individuals

Cited by 40 publications

References 129 publications

Severity of inducible myocardial ischemia predicts incident acute coronary syndromes in asymptomatic individuals with a family history of premature coronary artery disease

Severity of inducible myocardial ischemia predicts incident acute coronary syndromes in asymptomatic individuals with a family history of premature coronary artery disease

The future of SPECT MPI: Time and dose reduction

Prognostic value of coronary artery calcium score in combination with cardiac stress sigle-photon emission tomography imaging in an asymptomatic population

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