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Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy

Edenbrandt, Lars LU ; Ohlsson, Mattias LU and Trägårdh, Elin LU (2013) In EJNMMI Research 3(1).
Abstract

Background: Stress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data. Methods: All 4,820 patients who underwent 99mTc MPS at Skåne University Hospital in Malmö, Sweden, in... (More)

Background: Stress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data. Methods: All 4,820 patients who underwent 99mTc MPS at Skåne University Hospital in Malmö, Sweden, in 2004 to 2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin. Results: A total of 3,426 patients with a normal perfusion study were included. Of these, 2,215 patients had a stress-only study and 1,211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p < 0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p < 0.0001 for all comparisons). Regarding left ventricular function data, we did not find any significant difference in event rate between normal vs. abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF, and EDV vs. abnormal EF or EDV for either the normal stressonly patients or the normal stress-rest patients. Conclusions: Patients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ischemic heart disease, Myocardial perfusion imaging, Prognostic value
in
EJNMMI Research
volume
3
issue
1
publisher
BioMed Central
external identifiers
  • scopus:84887314582
  • wos:000209435800058
ISSN
2191-219X
DOI
10.1186/2191-219X-3-58
language
English
LU publication?
no
id
ae3f019f-18f3-496b-9146-7342c8527257
date added to LUP
2017-05-16 16:25:18
date last changed
2018-06-03 04:56:47
@article{ae3f019f-18f3-496b-9146-7342c8527257,
  abstract     = {<p>Background: Stress myocardial perfusion scintigraphy (MPS) is widely regarded as a useful imaging modality for diagnosing patients with suspected ischemic heart disease. Current European guidelines recommend stress study to be performed first since rest study can be omitted if stress study is interpreted as normal. Thus, a rest study should only be performed in patients with equivocal or abnormal studies. The aim of the present study was to investigate the prognosis of a normal stress-only MPS compared to a normal stress-rest MPS in a retrospective manner and also with regard to normal/abnormal left ventricular function data. Methods: All 4,820 patients who underwent <sup>99m</sup>Tc MPS at Skåne University Hospital in Malmö, Sweden, in 2004 to 2007, for suspected or management of known ischemic heart disease were considered. The physician in clinical charge of the investigation decided whether a rest study was necessary or not. Based on the final report according to clinical routine, only patients with a normal perfusion study (no infarction or inducible ischemia) were included. The endpoints were non-fatal acute coronary syndrome or death from ischemic cardiac origin. Results: A total of 3,426 patients with a normal perfusion study were included. Of these, 2,215 patients had a stress-only study and 1,211 patients had both stress and rest studies. Mean follow-up was 6.2 years. The lowest event rate was found in the normal stress-only group (0.56% for normal stress-only patients vs. 1.42% for normal stress-rest patients; p &lt; 0.0001). When dividing patients according to sex and stress type, the best prognosis was also found in the normal stress-only group (p &lt; 0.0001 for all comparisons). Regarding left ventricular function data, we did not find any significant difference in event rate between normal vs. abnormal ejection fraction (EF), normal vs. abnormal end-diastolic volume (EDV) or normal EF, and EDV vs. abnormal EF or EDV for either the normal stressonly patients or the normal stress-rest patients. Conclusions: Patients with a normal stress-only study had an excellent prognosis over a mean follow-up time of 6 years. Thus, omitting the rest study if the stress study is normal is a safe procedure.</p>},
  author       = {Edenbrandt, Lars and Ohlsson, Mattias and Trägårdh, Elin},
  issn         = {2191-219X},
  keyword      = {Ischemic heart disease,Myocardial perfusion imaging,Prognostic value},
  language     = {eng},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {EJNMMI Research},
  title        = {Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy},
  url          = {http://dx.doi.org/10.1186/2191-219X-3-58},
  volume       = {3},
  year         = {2013},
}