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BMC Medical Physics
Published in: BMC Medical Physics 1/2006

Open Access 01-12-2006 | Research article

Prognostic utility of sestamibi lung uptake does not require adjustment for stress-related variables: A retrospective cohort study

Authors: William D Leslie, Marina S Yogendran, Linda M Ward, Khaled A Nour, Colleen J Metge

Published in: BMC Medical Physics | Issue 1/2006

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Abstract

Background

Increased 99mTc-sestamibi stress lung-to-heart ratio (sLHR) has been shown to predict cardiac outcomes similar to pulmonary uptake of thallium. Peak heart rate and use of pharmacologic stress affect the interpretation of lung thallium uptake. The current study was performed to determine whether 99mTc-sestamibi sLHR measurements are affected by stress-related variables, and whether this in turn affects prognostic utility.

Methods

sLHR was determined in 718 patients undergoing 99mTc-sestamibi SPECT stress imaging. sLHR was assessed in relation to demographics, hemodynamic variables and outcomes (mean follow up 5.6 ± 1.1 years).

Results

Mean sLHR was slightly greater in males than in females (P < 0.01) and also showed a weak negative correlation with age (P < 0.01) and systolic blood pressure (P < 0.01), but was unrelated to stress method or heart rate at the time of injection. In patients undergoing treadmill exercise, sLHR was also positively correlated with peak workload (P < 0.05) but inversely with double product (P < 0.05). The combined explanatory effect of sex, age and hemodynamic variables on sLHR was less than 10%. The risk of acute myocardial infarction (AMI) or death increased by a factor of 1.7–1.8 for each SD increase in unadjusted sLHR, and was unaffected by adjustment for sex, age and hemodynamic variables (hazard ratios 1.6–1.7). The area under the ROC curve for the unadjusted sLHR was 0.65 (95% CI 0.59–0.71, P < 0.0001) and was unchanged for the adjusted sLHR (0.65, 95% CI 0.61–0.72, P < 0.0001).

Conclusion

Stress-related variables have only a weak effect on measured sLHR. Unadjusted and adjusted sLHR provide equivalent prognostic information for prediction of AMI or death.
Appendix
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Literature
1.
Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, Friedman JD, Germano G, Van Train K, Diamond GA: Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995, 26: 639-647. 10.1016/0735-1097(95)00218-S.CrossRefPubMed
2.
Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA: Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation. 1996, 93: 905-914.CrossRefPubMed
3.
Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA: 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: 535-543.CrossRefPubMed
4.
Hansen CL, Sangrigoli R, Nkadi E, Kramer M: Comparison of pulmonary uptake with transient cavity dilation after exercise thallium-201 perfusion imaging. J Am Coll Cardiol. 1999, 33: 1323-1327. 10.1016/S0735-1097(98)00699-8.CrossRefPubMed
5.
Klocke FJ, Baird MG, Lorell BH, Bateman TM, Messer JV, Berman DS, O'Gara PT, Carabello BA, Russell ROJ, Cerqueira MD, John Sutton MG, DeMaria AN, Udelson JE, Kennedy JW, Verani MS, Williams KA, Antman EM, Smith SCJ, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Faxon DP, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO: ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003, 42: 1318-1333. 10.1016/j.jacc.2003.08.011.CrossRefPubMed
6.
Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ: Prognostic value of lung sestamibi uptake in myocardial perfusion imaging of patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2004
7.
Brown KA, Boucher CA, Okada RD, Strauss HW, Pohost GM: Quantification of pulmonary thallium-201 activity after upright exercise in normal persons: importance of peak heart rate and propranolol usage in defining normal values. Am J Cardiol. 1984, 53: 1678-1682. 10.1016/0002-9149(84)90601-5.CrossRefPubMed
8.
Nishimura T, Uehara T, Hayashida K, Kozuka T, Saito M, Sumiyoshi T: Quantitative assessment of thallium myocardial washout rate: importance of peak heart rate and lung thallium uptake in defining normal values. Eur J Nucl Med. 1987, 13: 67-71.PubMed
9.
Mahmood S, Buscombe JR, Ell PJ: The use of thallium-201 lung/heart ratios. Eur J Nucl Med. 1992, 19: 807-814. 10.1007/BF00182824.CrossRefPubMed
10.
Leslie WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ: Automated quantification of 99mTc sestamibi myocardial perfusion compared with visual analysis. Nucl Med Commun. 2004, 25: 833-838. 10.1097/01.mnm.0000133075.72292.53.CrossRefPubMed
11.
Germano G, Kavanagh PB, Chen J, Waechter P, Su HT, Kiat H, Berman DS: Operator-less processing of myocardial perfusion SPECT studies. J Nucl Med. 1995, 36: 2127-2132.PubMed
12.
Germano G, Kavanagh PB, Su HT, Mazzanti M, Kiat H, Hachamovitch R, Van Train KF, Areeda JS, Berman DS: Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. J Nucl Med. 1995, 36: 1107-1114.PubMed
13.
Germano G, Kavanagh PB, Berman DS: An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images. Int J Card Imaging. 1997, 13: 337-346. 10.1023/A:1005815206195.CrossRefPubMed
14.
Germano G, Kavanagh PB, Waechter P, Areeda J, Van Kriekinge S, Sharir T, Lewin HC, Berman DS: A new algorithm for the quantitation of myocardial perfusion SPECT. I: technical principles and reproducibility. J Nucl Med. 2000, 41: 712-719.PubMed
15.
Sharir T, Germano G, Waechter PB, Kavanagh PB, Areeda JS, Gerlach J, Kang X, Lewin HC, Berman DS: A new algorithm for the quantitation of myocardial perfusion SPECT. II: validation and diagnostic yield. J Nucl Med. 2000, 41: 720-727.PubMed
16.
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: 204-211.PubMed
17.
Abidov A, Bax JJ, Hayes SW, Hachamovitch R, Cohen I, Gerlach J, Kang X, Friedman JD, Germano G, Berman DS: Transient ischemic dilation ratio of the left ventricle is a significant predictor of future cardiac events in patients with otherwise normal myocardial perfusion SPECT. J Am Coll Cardiol. 2003, 19;42: 1818-1825. 10.1016/j.jacc.2003.07.010.CrossRef
18.
Bacher-Stier C, Sharir T, Kavanagh PB, Lewin HC, Friedman JD, Miranda R, Germano G, Berman DS: Postexercise lung uptake of 99mTc-sestamibi determined by a new automatic technique: validation and application in detection of severe and extensive coronary artery disease and reduced left ventricular function. J Nucl Med. 2000, 41: 1190-1197.PubMed
19.
Roos NP, Shapiro E: Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system. Med Care. 1999, 37: JS10-JS14. 10.1097/00005650-199906001-00005.PubMed
20.
Roos LL, Mustard CA, Nicol JP, McLerran DF, Malenka DJ, Young TK, Cohen MM: Registries and administrative data: organization and accuracy. Med Care. 1993, 31: 201-212.CrossRefPubMed
21.
Roos LL, Sharp SM, Wajda A: Assessing data quality: a computerized approach. Soc Sci Med. 1989, 28: 175-182. 10.1016/0277-9536(89)90145-7.CrossRefPubMed
22.
Tu JV, Austin PC, Walld R, Roos L, Agras J, McDonald KM: Development and validation of the Ontario acute myocardial infarction mortality prediction rules. J Am Coll Cardiol. 2001, 37: 992-997. 10.1016/S0735-1097(01)01109-3.CrossRefPubMed
23.
Blanchard JF, Ludwig S, Wajda A, Dean H, Anderson K, Kendall O, Depew N: Incidence and prevalence of diabetes in Manitoba, 1986-1991. Diabetes Care. 1996, 19: 807-811.CrossRefPubMed
24.
Nordrehaug JE, Danielsen R, Vik-Mo H: Physiological inverse relationship between heart rate and thallium-201 lung uptake, clearance and lung/myocardial uptake ratio. Eur Heart J. 1990, 11: 628-633.CrossRefPubMed
25.
Romanens M, Gradel C, Saner H, Pfisterer M: Comparison of 99mTc-sestamibi lung/heart ratio, transient ischaemic dilation and perfusion defect size for the identification of severe and extensive coronary artery disease. Eur J Nucl Med. 2001, 28: 907-910. 10.1007/s002590100532.CrossRefPubMed
26.
Berman M, Gewirtz H: Acute effects of 17 beta-estradiol on the coronary microcirculation: observations in sedated, closed-chest domestic swine. Coron Artery Dis. 1997, 8: 351-361.CrossRefPubMed
27.
Duvernoy CS, Meyer C, Seifert-Klauss V, Dayanikli F, Matsunari I, Rattenhuber J, Hoss C, Graeff H, Schwaiger M: Gender differences in myocardial blood flow dynamics: lipid profile and hemodynamic effects. J Am Coll Cardiol. 1999, 33: 463-470. 10.1016/S0735-1097(98)00575-0.CrossRefPubMed
28.
Chareonthaitawee P, Kaufmann PA, Rimoldi O, Camici PG: Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res. 2001, 50: 151-161. 10.1016/S0008-6363(01)00202-4.CrossRefPubMed
29.
Uren NG, Camici PG, Melin JA, Bol A, de Bruyne B, Radvan J, Olivotto I, Rosen SD, Impallomeni M, Wijns W: Effect of aging on myocardial perfusion reserve. J Nucl Med. 1995, 36: 2032-2036.PubMed
30.
Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, Friedman JD, Zellweger MJ, Berman DS: Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation. 1999, 100: 1035-1042.CrossRefPubMed
Metadata
Title
Prognostic utility of sestamibi lung uptake does not require adjustment for stress-related variables: A retrospective cohort study
Authors
William D Leslie
Marina S Yogendran
Linda M Ward
Khaled A Nour
Colleen J Metge
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Medical Physics / Issue 1/2006
Electronic ISSN: 1756-6649
DOI
https://doi.org/10.1186/1471-2385-6-2

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