ORIGINAL ARTICLES  AN OVERVIEW OF THE RADIOPHARMACOLOGY FIELD TO DATE 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2008 September;52(3):296-304

Copyright © 2008 EDIZIONI MINERVA MEDICA

lingua: Inglese

Poststress left ventricular ejection fraction is an independent predictor of major cardiac events in patients with coronary artery disease and impaired left ventricular function

De Winter O. ¹, Van De Veire N. ², De Bondt P. ¹, Van De Wiele C. ¹, De Buyzere M. ², De Backer G. ³, Gillebert T. C. ², Dierckx R. A. ¹, De Sutter J. ²

¹ Nuclear Medicine Division Ghent University Hospital Ghent, Belgium 2 Department of Cardiovascular Diseases Ghent University Hospital, Ghent, Belgium 3 Cardiac Rehabilitation Center Ghent University Hospital, Ghent, Belgium

Aim. The aim of this study was to investigate the prognostic value of myocardial perfusion and function SPECT imaging in patients with coronary artery disease (CAD) and poor left ventricular (LV) function.
Methods. We studied 261 patients (231 men, age 66±10 years) with CAD and a resting LV ejection fraction (LVEF) ≤40% assessed during myocardial gated SPECT. Perfusion defect extent was calculated using 4D-MSPECT® software (Michigan University). Ischemia scoring was performed visually. Considered end points were: 1) major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction or late revascularization), 2) MACE or the need for hospitalization due to heart failure (MACE-HF) and 3) cardiac death or non-fatal myocardial infarction.
Results. During a median follow-up of 31 months, 52 patients (20%) died (35 cardiac deaths), 50 (19%) developed a MACE and 69 (26%) a MACE-HF. In a clinical model, diabetes and angina status were the only predictors of MACE (χ2=19.3; P<0.001). By multivariate analysis, poststress LVEF (χ2-gain of 6.4; P=0.008) and presence of ischemia (χ2-gain of 5.8; P=0.018) were predictive of MACE. Similarly, diabetes mellitus (χ2=12.1; P<0.001), poststress LVEF (χ2-gain of 5.5; P=0.019) and presence of ischemia (χ2-gain of 4.3; P=0.044) were independent predictors of MACE-HF. Diabetes mellitus (χ2=17.8; P<0.001), presence of angina complaints (χ2-gain of 6.8; P=0.028) and poststress LVEF (χ2-gain of 6.3; P=0.008) were independent predictors of cardiac death or non-fatal myocardial infarction.
Conclusion. In patients with impaired LV function and CAD, poststress LVEF is an independent predictor of future cardiac events