Review ArticleReview of cardiovascular imaging in the Journal of Nuclear Cardiology 2019: Single-photon emission computed tomography
Section snippets
Diagnosis and Prognosis
The use of myocardial perfusion imaging (MPI) for diagnosis and risk stratification in patients with or suspected of having coronary artery disease (CAD) is well supported by a wealth of large studies.10 Alonso et al.11 developed a machine learning model to estimate a patient’s risk of cardiac death based on MPI. To do this, they used data from 8321 patients who underwent vasodilator MPI and experienced 551 subsequent cardiac deaths during a mean follow-up period of 3 years. The linear
Non-perfusion Variables
MPI provides a wealth of prognostic variables aside from assessment of left ventricular perfusion.28 One of the most important prognostic indicators on exercise MPI is functional capacity. However, cardiopulmonary exercise testing provides multiple objective parameters on cardiac and pulmonary status. Christopoulos et al.29 found that cardiopulmonary exercise testing provided information that was incremental to MPI and led to changes in clinical decision-making and prompted further evaluation
Safety of Testing
Vasodilator stress MPI is widely used and there are substantial data on its safety,42, 43, 44 but the safety data on older adults are limited. Katsikis et al.45 evaluated the tolerability, safety and prognostic implication of adenosine MPI in 370 octogenarians (49% of which had known CAD) who underwent testing for clinical indications. There were no deaths, myocardial infarctions, sustained ventricular arrhythmias or advanced atrioventricular block seen. One patient experienced pulmonary edema
Heart Failure
MPI has a vital role in the evaluation of patients with heart failure. CZT cameras have revolutionized our field for the assessment of myocardial ischemia. Wu et al.51 evaluated patients with heart failure who underwent rest 99m-Tc MPI using CZT camera and a conventional Anger camera in addition to FDG PET within 3 days. There was good correlation between the two technologies in assessment of summed rest score (CZT tended to underestimate compared to conventional) and in assessing
Renal Disease
Patients with renal disease are known to be at increased risk of cardiovascular events and deaths. Previous studies have established the role of MPI in risks stratification of this high-risk cohort.64,65 Nakamura et al.66 reported the results of the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS 3), a multi-center prospective cohort study of 529 patients with chronic kidney disease who underwent MPI and followed up for 3 years. Cardiac risk was
Disclosure
Dr. Hage reports research grant support from Astellas Pharma and GE Healthcare. Dr. AlJaroudi reports no disclosures.
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