Key result
An abnormal stress myocardial perfusion imaging score (summed difference score ≥4) significantly predicted cardiac events (HR 4.2) in patients without chest pain but with mildly impaired systolic left ventricular function or left ventricular asynergy.
Why the study?
Does stress myocardial perfusion imaging predict cardiac events in patients with mildly impaired systolic LV function or LV asynergy without chest pain but with suspected CAD?
Cohort (n=72)
No
Does stress myocardial perfusion imaging predict cardiac events in patients with mildly impaired systolic LV function or LV asynergy without chest pain but with suspected CAD?
Hazard Ratio: 4.2 (95% CI 1.4–12.4)
p-value: p=0.01
Stress myocardial perfusion imaging demonstrating a summed difference score ≥4 strongly predicts future cardiac events in asymptomatic patients with mildly impaired LV function and suspected CAD.
May aid risk stratification in asymptomatic mild LV dysfunction; leaves open whether imaging-guided therapy improves outcomes.
BACKGROUND: The prognostic value of myocardial perfusion imaging (MPI) was investigated in patients with mildly impaired left ventricular (LV) function who had no chest pain but were suspected to have coronary artery disease (CAD). METHODS AND RESULTS: Consecutive patients (n=72, mean age =67) who had no chest pain but with mildly impaired systolic LV function (mean LV ejection fraction =52%) or LV asynergy and suspected to have CAD were followed up for 4.9 years after stress MPI. The follow-up time was censored at the occurrence of cardiac death, hospitalization for congestive heart failure (CHF), acute coronary syndromes (ACS), or revascularization. Images were scored using a 20-segment model and a 0-4 scale, and then the summed stress, rest, and difference scores (SDS) were calculated. During follow-up, there were 2 cases of cardiac death, 8 of hospitalization for CHF, 4 of ACS and 2 of revascularization. Cox regression demonstrated that SDS >or=4 was an excellent predictor of cardiac events in all patients (hazard ratio =4.2, p=0.01), and especially in diabetic patients (hazard ratio =28.4, p=0.01). CONCLUSION: Stress MPI is useful for predicting cardiac events and may be performed in patients without chest pain if they have mildly impaired systolic LV function or LV asynergy.
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Nakazato et al. (2006) conducted a cohort in Mildly impaired systolic left ventricular function or left ventricular asynergy without chest pain (n=72). Abnormal stress myocardial perfusion imaging (Summed Difference Score ≥4) vs. Normal stress myocardial perfusion imaging (Summed Difference Score <4) was evaluated on Cardiac events (cardiac death, hospitalization for congestive heart failure, acute coronary syndromes, or revascularization) (HR 4.2, 95% CI 1.4-12.4, p=0.01). An abnormal stress myocardial perfusion imaging score (summed difference score ≥4) significantly predicted cardiac events (HR 4.2) in patients without chest pain but with mildly impaired systolic left ventricular function or left ventricular asynergy.
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