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Prognostic value of stress-only and stress-rest normal gated SPECT imaging: higher incidence of cardiac hard events in diabetic patients who underwent full stress-rest imaging
M. Kaminek, I. Metelkova, M. Budikova, L. Henzlova, P. Koranda, V. Kincl, A. Drozdova
Language English Country Czech Republic
Document type Journal Article, Research Support, Non-U.S. Gov't
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- MeSH
- Time Factors MeSH
- Diabetes Mellitus physiopathology MeSH
- Incidence MeSH
- Myocardial Ischemia diagnostic imaging epidemiology etiology MeSH
- Tomography, Emission-Computed, Single-Photon * MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Prognosis MeSH
- Risk Factors MeSH
- Exercise Test methods MeSH
- Myocardial Perfusion Imaging methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: The European procedural guidelines for cardiac gated SPECT imaging demonstrate considerable variability in recommended administered radiopharmaceutical activity and imaging protocols. This study compared stress-only and stress-rest protocols to evaluate the safety of stress-only imaging, and to identify characteristics of patients who need full stress-rest imaging. METHODS: Patients referred for a chest pain were scheduled for stress-rest gated SPECT imaging. If the stress images were interpreted as normal according to the perfusion and left ventricular function, the examination of patients was finished and patients did not undergo the rest imaging. A total number of 1063 patients was included (mean age 61 ± 11 years). These patients have been followed for hard cardiac events, i.e. cardiac deaths or nonfatal myocardial infarction. RESULTS: During a follow-up of 3.2 ± 2.5 years, hard events occurred in 12 patients with normal SPECT and 59 with abnormal SPECT had hard events (0.7 vs. 3.6% /year, P < 0.001). Among the 536 patients with normal study, there was no significantly lower incidence of hard events in the subgroup of patients with stress-only imaging (0.6 vs. 0.8% /year, P = 0.641). Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT (1.3 vs. 0.5%/year, P < 0.001). We found a higher incidence of hard events in diabetic patients with normal study with the necessity of full stress-rest imaging in comparison with those with stress-only imaging (1.7 vs. 0.7% /year, P < 0.001). CONCLUSIONS: Our results support the good prognosis of normal stress-only study. Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT. Diabetic patients with normal results who required additional rest imaging had significant adverse outcome.
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