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Published in: Journal of Nuclear Cardiology 6/2020

01-12-2020 | Hypercholesterolemia | Original Article

Temporal trends of abnormal myocardial perfusion imaging in a cohort of Italian subjects: Relation with cardiovascular risk factors

Authors: Rosario Megna, PhD, Emilia Zampella, MD, PhD, Roberta Assante, MD, PhD, Carmela Nappi, MD, Valeria Gaudieri, MD, PhD, Teresa Mannarino, MD, Valeria Cantoni, PhD, Roberta Green, PhD, Stefania Daniele, MS, Ciro Gabriele Mainolfi, MD, Wanda Acampa, MD, PhD, Mario Petretta, MD, Alberto Cuocolo, MD

Published in: Journal of Nuclear Cardiology | Issue 6/2020

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Abstract

Background

The frequency of abnormal stress single-photon emission computed tomography myocardial perfusion imaging (MPS) has decreased over the past decades despite an increase in the prevalence of cardiovascular risk factors. This study evaluated the temporal trend of abnormal stress MPS and its relationship with risk factors in a cohort of Italian subjects.

Methods

We included all patients who underwent clinically indicated stress MPS at our academic center between January 2006 and December 2017. Patients were assessed for change in demographics, clinical symptoms, risk factors, and frequency of abnormal and ischemic MPS.

Results

A total of 8,886 stress MPS studies were performed (3,350 abnormal). Age, male gender, diabetes, smoking, and angina were independent predictors of abnormal MPS. There was a slight decline in the frequency of abnormal (from 39 to 36%, P < 0.05) and ischemic (from 25 to 22%, P < 0.01) MPS during the study period, while the percentage of patients with hypertension, hypercholesterolemia, smoking, and angina increased. The Cochran-Mantel-Haenszel test indicates that the likelihood of having an abnormal MPS did not change over time for age, diabetes, smoking, and a history of coronary artery disease (CAD), increased for hypertension and hypercholesterolemia and decreased for male compared to female gender.

Conclusions

In our cohort of Italian subjects, there was a slight temporal decline in the frequency of abnormal and ischemic MPS despite an increase over time in the prevalence of many cardiac risk factors. These results strengthen the need to develop more effective strategies for appropriately referring patients to cardiac imaging procedures.
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Literature
1.
go back to reference Sytkowski PA, Kannel WB, D’Agostino RB. Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med 1990;322:1635-41.CrossRef Sytkowski PA, Kannel WB, D’Agostino RB. Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med 1990;322:1635-41.CrossRef
2.
go back to reference Myerson M, Coady S, Taylor H, Rosamond WD, Goff DC Jr, ARIC Investigators. Declining severity of myocardial infarction from1987 to 2002: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2009;119:503-14.CrossRef Myerson M, Coady S, Taylor H, Rosamond WD, Goff DC Jr, ARIC Investigators. Declining severity of myocardial infarction from1987 to 2002: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2009;119:503-14.CrossRef
3.
go back to reference Levitan EB, Tanner RM, Zhao H, Muntner P, Thacker EL, Howard G, et al. Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease. Int J Cardiol 2014;174:436-9.CrossRef Levitan EB, Tanner RM, Zhao H, Muntner P, Thacker EL, Howard G, et al. Secular changes in rates of coronary heart disease, fatal coronary heart disease, and out-of-hospital fatal coronary heart disease. Int J Cardiol 2014;174:436-9.CrossRef
4.
go back to reference Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Writing Group Members, American Heart Association Statistics Committee; Stroke Statistics Subcommittee, et al. Executive summary: Heart disease and stroke statistics–2016 update: A report from the American Heart Association. Circulation 2016;133:447-54.CrossRef Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Writing Group Members, American Heart Association Statistics Committee; Stroke Statistics Subcommittee, et al. Executive summary: Heart disease and stroke statistics–2016 update: A report from the American Heart Association. Circulation 2016;133:447-54.CrossRef
5.
go back to reference GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;385:117-71.
6.
go back to reference Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging 2012;5:700-7.CrossRef Parker MW, Iskandar A, Limone B, Perugini A, Kim H, Jones C, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: a bivariate meta-analysis. Circ Cardiovasc Imaging 2012;5:700-7.CrossRef
7.
go back to reference Cantoni V, Green R, Acampa W, Petretta M, Bonaduce D, Salvatore M, et al. Long-term prognostic value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis. J Nucl Cardiol 2016;23:185-97.CrossRef Cantoni V, Green R, Acampa W, Petretta M, Bonaduce D, Salvatore M, et al. Long-term prognostic value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis. J Nucl Cardiol 2016;23:185-97.CrossRef
8.
go back to reference Green R, Cantoni V, Petretta M, Acampa W, Panico M, Buongiorno P, et al. Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis. J Nucl Cardiol 2018;25:1588-97.CrossRef Green R, Cantoni V, Petretta M, Acampa W, Panico M, Buongiorno P, et al. Negative predictive value of stress myocardial perfusion imaging and coronary computed tomography angiography: A meta-analysis. J Nucl Cardiol 2018;25:1588-97.CrossRef
9.
go back to reference Acampa W, Petretta M, Evangelista L, Nappi G, Luongo L, Petretta MP, et al. Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events. J Thorac Cardiovasc Surg 2008;136:46-51.CrossRef Acampa W, Petretta M, Evangelista L, Nappi G, Luongo L, Petretta MP, et al. Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events. J Thorac Cardiovasc Surg 2008;136:46-51.CrossRef
10.
go back to reference Petretta M, Acampa W, Evangelista L, Daniele S, Zampella E, Assante R, et al. Reclassification of cardiovascular risk by myocardial perfusion imaging in diabetic patients with abnormal resting electrocardiogram. Nutr Metab Cardiovasc Dis 2014;24:588-93.CrossRef Petretta M, Acampa W, Evangelista L, Daniele S, Zampella E, Assante R, et al. Reclassification of cardiovascular risk by myocardial perfusion imaging in diabetic patients with abnormal resting electrocardiogram. Nutr Metab Cardiovasc Dis 2014;24:588-93.CrossRef
11.
go back to reference Rozanski A, Gransar H, Hayes SW, Min J, Friedman JD, Thomson LE, et al. Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009. J Am Coll Cardiol 2013;61:1054-65.CrossRef Rozanski A, Gransar H, Hayes SW, Min J, Friedman JD, Thomson LE, et al. Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009. J Am Coll Cardiol 2013;61:1054-65.CrossRef
12.
go back to reference Duvall WL, Rai M, Ahlberg AW, O’Sullivan DM, Henzlova MJ. A multi-center assessment of the temporal trends in myocardial perfusion imaging. J Nucl Cardiol 2015;22:539-51.CrossRef Duvall WL, Rai M, Ahlberg AW, O’Sullivan DM, Henzlova MJ. A multi-center assessment of the temporal trends in myocardial perfusion imaging. J Nucl Cardiol 2015;22:539-51.CrossRef
13.
go back to reference Jouni H, Askew JW, Crusan DJ, Miller TD, Gibbons RJ. Temporal trends of single-photon emission computed tomography myocardial perfusion imaging in patients without prior coronary artery disease: A 22-year experience at a tertiary academic medical center. Am Heart J 2016;176:127-33.CrossRef Jouni H, Askew JW, Crusan DJ, Miller TD, Gibbons RJ. Temporal trends of single-photon emission computed tomography myocardial perfusion imaging in patients without prior coronary artery disease: A 22-year experience at a tertiary academic medical center. Am Heart J 2016;176:127-33.CrossRef
14.
go back to reference Jouni H, Askew JW, Crusan DJ, Miller TD, Gibbons RJ. Temporal trends of single-photon emission computed tomography myocardial perfusion imaging in patients with coronary artery disease: A 22-year experience from a tertiary academic medical center. Circ Cardiovasc Imaging 2017;10:e005628.PubMed Jouni H, Askew JW, Crusan DJ, Miller TD, Gibbons RJ. Temporal trends of single-photon emission computed tomography myocardial perfusion imaging in patients with coronary artery disease: A 22-year experience from a tertiary academic medical center. Circ Cardiovasc Imaging 2017;10:e005628.PubMed
15.
go back to reference Thompson RC, Allam AH. More risk factors, less ischemia, and the relevance of MPI testing. J Nucl Cardiol 2015;22:552-4.CrossRef Thompson RC, Allam AH. More risk factors, less ischemia, and the relevance of MPI testing. J Nucl Cardiol 2015;22:552-4.CrossRef
16.
17.
go back to reference Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines), et al. ACC/AHA 2002 guideline update for exercise testing: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;2002(106):1883-92. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines), et al. ACC/AHA 2002 guideline update for exercise testing: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;2002(106):1883-92.
18.
go back to reference Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, European Association of Nuclear Medicine (EANM), et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;2015(42):1929-40.CrossRef Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, European Association of Nuclear Medicine (EANM), et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;2015(42):1929-40.CrossRef
19.
go back to reference Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 2004;11:414-23.CrossRef Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 2004;11:414-23.CrossRef
20.
go back to reference Chen T, Guestrin C. XGBoost: A scalable tree boosting system. In: Proceedings of the 22Nd ACM SIGKDD international conference on knowledge discovery and data mining, 785–94. ACM, 2016. Chen T, Guestrin C. XGBoost: A scalable tree boosting system. In: Proceedings of the 22Nd ACM SIGKDD international conference on knowledge discovery and data mining, 785–94. ACM, 2016.
21.
go back to reference Friedman JH. Greedy function approximation: A gradient boosting machine. Ann Stat 2001;29:1189-232.CrossRef Friedman JH. Greedy function approximation: A gradient boosting machine. Ann Stat 2001;29:1189-232.CrossRef
23.
go back to reference Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease: Insights from the promise trial. JACC Cardiovasc Imaging 2016;9:337-46.CrossRef Hemal K, Pagidipati NJ, Coles A, Dolor RJ, Mark DB, Pellikka PA, et al. Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease: Insights from the promise trial. JACC Cardiovasc Imaging 2016;9:337-46.CrossRef
24.
go back to reference American Heart Association/American Stroke Association. Cardiovascular Disease: Women’s No. 1 Health Threat. https://www.heart.org/-/media/files/about-us/policy-research/fact-sheets/facts-cvd-womens-no-1-health-threat.pdf. Accessed December 12 2018. American Heart Association/American Stroke Association. Cardiovascular Disease: Women’s No. 1 Health Threat. https://​www.​heart.​org/​-/​media/​files/​about-us/​policy-research/​fact-sheets/​facts-cvd-womens-no-1-health-threat.​pdf.​ Accessed December 12 2018.
25.
go back to reference Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: Evolving knowledge. J Am Coll Cardiol 2009;54:1561-75.CrossRef Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: Evolving knowledge. J Am Coll Cardiol 2009;54:1561-75.CrossRef
26.
go back to reference Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA MA, American Heart Association national survey. Fifteen-year trends in awareness of heart disease in women: Results of a 2012 American Heart Association national survey. Circulation 2012;2013:1254-63. Mosca L, Hammond G, Mochari-Greenberger H, Towfighi A, Albert MA MA, American Heart Association national survey. Fifteen-year trends in awareness of heart disease in women: Results of a 2012 American Heart Association national survey. Circulation 2012;2013:1254-63.
27.
go back to reference Chhabra L, Ahlberg AW, Henzlova MJ, Duvall WL. Temporal trends of stress myocardial perfusion imaging: Influence of diabetes, gender and coronary artery disease status. Int J Cardiol 2016;202:922-9.CrossRef Chhabra L, Ahlberg AW, Henzlova MJ, Duvall WL. Temporal trends of stress myocardial perfusion imaging: Influence of diabetes, gender and coronary artery disease status. Int J Cardiol 2016;202:922-9.CrossRef
28.
go back to reference Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Executive summary: Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation 2012;125:188-97.CrossRef Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Executive summary: Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation 2012;125:188-97.CrossRef
29.
go back to reference Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007;356:2388-98.CrossRef Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007;356:2388-98.CrossRef
30.
go back to reference Iskandrian AE, Hage FG. Declining frequency of ischemia detection using stress myocardial perfusion imaging. J Am Coll Cardiol 2013;61:1066-8.CrossRef Iskandrian AE, Hage FG. Declining frequency of ischemia detection using stress myocardial perfusion imaging. J Am Coll Cardiol 2013;61:1066-8.CrossRef
31.
go back to reference Acampa W, Rozza F, Zampella E, Assante R, Mannarino T, Nappi C, et al. Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis. J Nucl Cardiol. 2018. [Epub ahead of print]. Acampa W, Rozza F, Zampella E, Assante R, Mannarino T, Nappi C, et al. Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis. J Nucl Cardiol. 2018. [Epub ahead of print].
32.
go back to reference Nappi C, Acampa W, Nicolai E, Daniele S, Zampella E, Assante R, et al. Long-term prognostic value of low-dose normal stress-only myocardial perfusion imaging by wide beam reconstruction: A competing risk analysis. J Nucl Cardiol. 2018 Jul 19. [Epub ahead of print]. Nappi C, Acampa W, Nicolai E, Daniele S, Zampella E, Assante R, et al. Long-term prognostic value of low-dose normal stress-only myocardial perfusion imaging by wide beam reconstruction: A competing risk analysis. J Nucl Cardiol. 2018 Jul 19. [Epub ahead of print].
Metadata
Title
Temporal trends of abnormal myocardial perfusion imaging in a cohort of Italian subjects: Relation with cardiovascular risk factors
Authors
Rosario Megna, PhD
Emilia Zampella, MD, PhD
Roberta Assante, MD, PhD
Carmela Nappi, MD
Valeria Gaudieri, MD, PhD
Teresa Mannarino, MD
Valeria Cantoni, PhD
Roberta Green, PhD
Stefania Daniele, MS
Ciro Gabriele Mainolfi, MD
Wanda Acampa, MD, PhD
Mario Petretta, MD
Alberto Cuocolo, MD
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Journal of Nuclear Cardiology / Issue 6/2020
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-019-01630-1

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