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Short- and long-term prognostic performance of exercise ECG and myocardial perfusion SPECT

Kraen, M. LU ; Akil, S. LU ; Hedén, B. LU ; Kjellström, B. LU ; Berg, J. LU orcid ; Ostenfeld, E. LU orcid ; Arheden, H. LU ; Carlsson, M. LU and Engblom, H. LU (2024) In Clinical Physiology and Functional Imaging 44(6). p.454-462
Abstract

Background: Myocardial perfusion SPECT (MPS) and exercise electrocardiography (Ex-ECG) results are of prognostic importance for short-term follow up duration. However, the value of MPS or Ex-ECG findings for long-term risk assessment is less evident as underlying risk factors for ischemic heart disease (IHD) gain in importance. Objectives: To assess the short- and long-term prognostic value of MPS and Ex-ECG in relation to known risk factors. Methods and Materials: An observational study of 908 patients (age 63 years, 49% male, 45% prior IHD) referred for MPS and Ex-ECG. Follow-up was divided into two periods (short-term: <5 years and long-term: >5 years). Cardiac events were defined as a composite of acute myocardial infarction,... (More)

Background: Myocardial perfusion SPECT (MPS) and exercise electrocardiography (Ex-ECG) results are of prognostic importance for short-term follow up duration. However, the value of MPS or Ex-ECG findings for long-term risk assessment is less evident as underlying risk factors for ischemic heart disease (IHD) gain in importance. Objectives: To assess the short- and long-term prognostic value of MPS and Ex-ECG in relation to known risk factors. Methods and Materials: An observational study of 908 patients (age 63 years, 49% male, 45% prior IHD) referred for MPS and Ex-ECG. Follow-up was divided into two periods (short-term: <5 years and long-term: >5 years). Cardiac events were defined as a composite of acute myocardial infarction, unstable angina, unplanned revascularization and cardiovascular death. Results: The composite endpoint occurred in 95 patients (short-term follow up) and in 94 patients (long-term follow up). In multivariable models stress testing had a strong predictive value for short-term follow up (HR for MPS = 2.9, CI = 1.9–4.5, p < 0.001 and HR for Ex-ECG = 2.1, CI 1.3–3.3, p = 0.002), but no predictive value for long-term follow up (HR for MPS = 0.9, CI = 0.5–1.5, p = 0.70 and HR for Ex-ECG = 1.0, CI = 0.6–1.6, p = 0.92). Male sex and prior IHD were significant predictors regardless of follow up duration. Age, diabetes and decreased exercise capacity were risk factors for long-term follow up. Conclusions: The prognostic value of MPS and Ex-ECG results are strong for short-term follow up but diminish over time and do not contribute significantly in multivariable models after 5 years. Long-term prognosis is primarily governed by underlying risk factors and exercise capacity.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
exercise capacity, exercise ECG, MPS, myocardial perfusion imaging, prognosis, SPECT
in
Clinical Physiology and Functional Imaging
volume
44
issue
6
pages
9 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85201391765
  • pmid:39154282
ISSN
1475-0961
DOI
10.1111/cpf.12899
language
English
LU publication?
yes
id
c8a10236-0c24-4583-8adc-2ccaa7a34068
date added to LUP
2024-11-04 09:55:14
date last changed
2025-07-29 08:41:51
@article{c8a10236-0c24-4583-8adc-2ccaa7a34068,
  abstract     = {{<p>Background: Myocardial perfusion SPECT (MPS) and exercise electrocardiography (Ex-ECG) results are of prognostic importance for short-term follow up duration. However, the value of MPS or Ex-ECG findings for long-term risk assessment is less evident as underlying risk factors for ischemic heart disease (IHD) gain in importance. Objectives: To assess the short- and long-term prognostic value of MPS and Ex-ECG in relation to known risk factors. Methods and Materials: An observational study of 908 patients (age 63 years, 49% male, 45% prior IHD) referred for MPS and Ex-ECG. Follow-up was divided into two periods (short-term: &lt;5 years and long-term: &gt;5 years). Cardiac events were defined as a composite of acute myocardial infarction, unstable angina, unplanned revascularization and cardiovascular death. Results: The composite endpoint occurred in 95 patients (short-term follow up) and in 94 patients (long-term follow up). In multivariable models stress testing had a strong predictive value for short-term follow up (HR for MPS = 2.9, CI = 1.9–4.5, p &lt; 0.001 and HR for Ex-ECG = 2.1, CI 1.3–3.3, p = 0.002), but no predictive value for long-term follow up (HR for MPS = 0.9, CI = 0.5–1.5, p = 0.70 and HR for Ex-ECG = 1.0, CI = 0.6–1.6, p = 0.92). Male sex and prior IHD were significant predictors regardless of follow up duration. Age, diabetes and decreased exercise capacity were risk factors for long-term follow up. Conclusions: The prognostic value of MPS and Ex-ECG results are strong for short-term follow up but diminish over time and do not contribute significantly in multivariable models after 5 years. Long-term prognosis is primarily governed by underlying risk factors and exercise capacity.</p>}},
  author       = {{Kraen, M. and Akil, S. and Hedén, B. and Kjellström, B. and Berg, J. and Ostenfeld, E. and Arheden, H. and Carlsson, M. and Engblom, H.}},
  issn         = {{1475-0961}},
  keywords     = {{exercise capacity; exercise ECG; MPS; myocardial perfusion imaging; prognosis; SPECT}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{454--462}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Clinical Physiology and Functional Imaging}},
  title        = {{Short- and long-term prognostic performance of exercise ECG and myocardial perfusion SPECT}},
  url          = {{http://dx.doi.org/10.1111/cpf.12899}},
  doi          = {{10.1111/cpf.12899}},
  volume       = {{44}},
  year         = {{2024}},
}