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01-12-2012 | Original Article

Prognostic value of quantitative high-speed myocardial perfusion imaging

Authors: Ryo Nakazato, MD, PhD, Daniel S. Berman, MD, Heidi Gransar, MSc, Mark Hyun, CNMT, Romalisa Miranda-Peats, MPH, Faith C. Kite, CNMT, Sean W. Hayes, MD, Louise E. J. Thomson, MBChB, John D. Friedman, MD, Alan Rozanski, MD, Piotr J. Slomka, PhD

Published in: Journal of Nuclear Cardiology | Issue 6/2012

Abstract

Background

We studied the prognostic value of fully automated quantitative analysis software applied to new solid-state, high-speed (HS) SPECT-myocardial perfusion imaging (MPI).

Methods

1,613 consecutive patients undergoing exercise or adenosine HS-MPI were followed for 2.6 ± 0.5 years for all-cause mortality (ACM). Automated quantitative software was used to compute stress total perfusion deficit (sTPD) and was compared to semi-quantitative visual analysis. MPI was characterized as 0% (normal), 1%-4% (minimal perfusion defect), 5%-10% (mildly abnormal), and >10% (moderately/severely abnormal).

Results

During follow-up, 79 patients died (4.9%). Annualized ACM increased with progressively increasing sTPD; 0% (0.87%), 1%-4% (1.94%), 5%-10% (3.10%), and >10% (5.33%) (log-rank P < .0001). While similar overall findings were observed with visual analysis, only sTPD demonstrated increased risk in patients with minimal perfusion defects. In multivariable analysis, sTPD > 10% was a mortality predictor (HR 3.03, 95% CI 1.30-7.09, P = .01). Adjusted mortality rate was substantial in adenosine MPI, but low in exercise MPI (9.0% vs 1.0%, P < .0001).

Conclusions

By quantitative analysis, ACM increases with increasing perfusion abnormality among patients undergoing stress HS-MPI. These findings confirm previous results obtained with visual analysis using conventional Anger camera imaging systems.

Berman D, Kang X, Van Train K, Lewin H, Cohen I, Areeda J, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1998;32:1987-95.PubMedCrossRef

Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of automated quantification of 99mTc-sestamibi myocardial perfusion imaging. J Nucl Med 2005;46:204-11.PubMed

Xu Y, Nakazato R, Hayes S, Hachamovitch R, Cheng VY, Gransar H, et al. Prognostic value of automated vs visual analysis for adenosine stress myocardial perfusion SPECT in patients without prior coronary artery disease: A case-control study. J Nucl Cardiol 2011;18:1003-10094. quiz 10-4.PubMedCrossRef

Dakik HA, Hwang WS, Jafar A, Kimball K, Verani MS, Mahmarian JJ. Prognostic value of quantitative stress myocardial perfusion imaging in unstable angina patients with negative cardiac enzymes and no new ischemic ECG changes. J Nucl Cardiol 2005;12:32-6.PubMedCrossRef

Shaw LJ, Cerqueira MD, Brooks MM, Althouse AD, Sansing VV, Beller GA, et al. Impact of left ventricular function and the extent of ischemia and scar by stress myocardial perfusion imaging on prognosis and therapeutic risk reduction in diabetic patients with coronary artery disease: Results from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. J Nucl Cardiol 2012;19:658-69.PubMedCrossRef

Sharir T, Slomka P, Hayes S, DiCarli M, Ziffer J, Martin W, et al. Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. J Am Coll Cardiol 2010;55:1965-74.PubMedCrossRef

Sharir T, Ben-Haim S, Merzon K, Prochorov V, Dickman D, Berman D. High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. JACC Cardiovasc Imaging 2008;1:156-63.PubMedCrossRef

Herzog BA, Buechel RR, Katz R, Brueckner M, Husmann L, Burger IA, et al. Nuclear myocardial perfusion imaging with a cadmium-zinc-telluride detector technique: Optimized protocol for scan time reduction. J Nucl Med 2010;51:46-51.PubMedCrossRef

Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: First clinical validation. Eur J Nucl Med Mol Imaging 2010;37:773-8.PubMedCrossRef

10.

Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: Multicenter comparison with standard dual detector cameras. J Nucl Cardiol 2009;16:927-34.PubMedCrossRef

11.

Slomka P, Patton J, Berman D, Germano G. Advances in technical aspects of myocardial perfusion SPECT imaging. J Nucl Cardiol 2009;16:255-76.PubMedCrossRef

12.

Garcia EV, Faber TL, Esteves FP. Cardiac dedicated ultrafast SPECT cameras: New designs and clinical implications. J Nucl Med 2011;52:210-7.PubMedCrossRef

13.

Nakazato R, Tamarappoo BK, Kang X, Wolak A, Kite F, Hayes SW, et al. Quantitative upright-supine high-speed SPECT myocardial perfusion imaging for detection of coronary artery disease: Correlation with invasive coronary angiography. J Nucl Med 2010;51:1724-31.PubMedCrossRef

14.

Duvall WL, Sweeny JM, Croft LB, Barghash MH, Kulkarni NK, Guma KA, et al. Comparison of high efficiency CZT SPECT MPI to coronary angiography. J Nucl Cardiol 2011;18:595-604.PubMedCrossRef

15.

Hachamovitch R, Berman D, Shaw L, Kiat H, Cohen I, Cabico J, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-43.PubMedCrossRef

16.

Rozanski A, Gransar H, Shaw LJ, Kim J, Miranda-Peats L, Wong ND, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing the EISNER (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research) prospective randomized trial. J Am Coll Cardiol 2011;57:1622-32.PubMedCrossRef

17.

Berman D, Kang X, Tamarappoo B, Wolak A, Hayes S, Nakazato R, et al. Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. JACC Cardiovasc Imaging 2009;2:273-82.PubMedCrossRef

18.

Patton J, Slomka P, Germano G, Berman D. Recent technologic advances in nuclear cardiology. J Nucl Cardiol 2007;14:501-13.PubMedCrossRef

19.

Gambhir S, Berman D, Ziffer J, Nagler M, Sandler M, Patton J, et al. A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera. J Nucl Med 2009;50:635-43.PubMedCrossRef

20.

Diamond G, Forrester J. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;300:1350-8.PubMedCrossRef

21.

Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol 2005;12:66-77.PubMedCrossRef

22.

Berman D, Kang X, Gransar H, Gerlach J, Friedman J, Hayes S, et al. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009;16:45-53.PubMedCrossRef

23.

Shaw L, Berman D, Maron D, Mancini G, Hayes S, Hartigan P, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 2008;117:1283-91.PubMedCrossRef

24.

Germano G, Kiat H, Kavanagh P, Moriel M, Mazzanti M, Su H, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138-47.PubMed

25.

Slomka P, Germano G, Kavanagh P, Javadi M, Berman D, Bengel F. Evaluation of a new automatic algorithm for quantification of ECG-gated 82Rb cardiac PET. J Nucl Med 2009;50:1167.CrossRef

26.

Sharir T, Germano G, Kang X, Lewin H, Miranda R, Cohen I, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: Risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001;42:831-7.PubMed

27.

Berman D, Kiat H, Friedman J, Wang F, van Train K, Matzer L, et al. Separate acquisition rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: A clinical validation study. J Am Coll Cardiol 1993;22:1455-64.PubMedCrossRef

28.

Hachamovitch R, Hayes S, Friedman J, Cohen I, Berman D. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-7.PubMedCrossRef

29.

Cheng VY, Berman DS, Rozanski A, Dunning AM, Achenbach S, Al-Mallah M, et al. Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: Results from the multinational coronary CT angiography evaluation for clinical outcomes: An International Multicenter Registry (CONFIRM). Circulation 2011;124:2423-32.PubMedCrossRef

30.

Xu Y, Hayes S, Ali I, Ruddy TD, Wells RG, Berman DS, et al. Automatic and visual reproducibility of perfusion and function measures for myocardial perfusion SPECT. J Nucl Cardiol 2010;17:1050-7.PubMedCrossRef

31.

Abidov A, Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Kang X, et al. Are shades of gray prognostically useful in reporting myocardial perfusion single-photon emission computed tomography? Circ Cardiovasc Imaging 2009;2:290-8.PubMedCrossRef

32.

Rozanski A, Gransar H, Hayes SW, Friedman JD, Hachamovitch R, Berman DS. Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT. J Nucl Cardiol 2010;17:999-1008.PubMedCrossRef

33.

Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: Time for a reassessment? J Am Coll Cardiol 1999;34:618-20.PubMedCrossRef

34.

Supariwala A, Uretsky S, Singh P, Memon S, Khokhar SS, Wever-Pinzon O, et al. Synergistic effect of coronary artery disease risk factors on long-term survival in patients with normal exercise SPECT studies. J Nucl Cardiol 2011;18:207-14.PubMedCrossRef

35.

Min JK, Gilmore A, Budoff MJ, Berman DS, O’Day K. Cost-effectiveness of coronary CT angiography versus myocardial perfusion SPECT for evaluation of patients with chest pain and no known coronary artery disease. Radiology 2010;254:801-8.PubMedCrossRef

36.

Ladapo JA, Jaffer FA, Hoffmann U, Thomson CC, Bamberg F, Dec W, et al. Clinical outcomes and cost-effectiveness of coronary computed tomography angiography in the evaluation of patients with chest pain. J Am Coll Cardiol 2009;54:2409-22.PubMedCrossRef

Title: Prognostic value of quantitative high-speed myocardial perfusion imaging
Authors: Ryo Nakazato, MD, PhD
Daniel S. Berman, MD
Heidi Gransar, MSc
Mark Hyun, CNMT
Romalisa Miranda-Peats, MPH
Faith C. Kite, CNMT
Sean W. Hayes, MD
Louise E. J. Thomson, MBChB
John D. Friedman, MD
Alan Rozanski, MD
Piotr J. Slomka, PhD
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Journal of Nuclear Cardiology / Issue 6/2012
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-012-9619-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic value of quantitative high-speed myocardial perfusion imaging

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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