Document Detail

Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role?
MedLine Citation:
PMID:  19643316     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to identify prospectively the prevalence of significant ischemia (> or =10% of the left ventricle [LV]) on exercise single-photon emission computed tomography (SPECT) imaging relative to workload achieved in consecutive patients referred for myocardial perfusion imaging (MPI).
BACKGROUND: High exercise capacity is a strong predictor of a good prognosis, and the role of MPI in patients achieving high workloads is questionable.
METHODS: Prospective analysis was performed on 1,056 consecutive patients who underwent quantitative exercise gated (99m)Tc-SPECT MPI, of whom 974 attained > or =85% of their maximum age-predicted heart rate. These patients were further divided on the basis of attained exercise workload (<7, 7 to 9, or > or =10 metabolic equivalents [METs]) and were compared for exercise test and imaging outcomes, particularly the prevalence of > or =10% LV ischemia. Individuals reaching > or =10 METs but <85% maximum age-predicted heart rate were also assessed.
RESULTS: Of these 974 subjects, 473 (48.6%) achieved > or =10 METs. This subgroup had a very low prevalence of significant ischemia (2 of 473, 0.4%). Those attaining <7 METs had an 18-fold higher prevalence (7.1%, p < 0.001). Of the 430 patients reaching > or =10 METs without exercise ST-segment depression, none had > or =10% LV ischemia. In contrast, the prevalence of > or =10% LV ischemia was highest in the patients achieving <10 METs with ST-segment depression (14 of 70, 19.4%).
CONCLUSIONS: In this referral cohort of patients with an intermediate-to-high clinical risk of coronary artery disease, achieving > or =10 METs with no ischemic ST-segment depression was associated with a 0% prevalence of significant ischemia. Elimination of MPI in such patients, who represented 31% (430 of 1,396) of all patients undergoing exercise SPECT in this laboratory, could provide substantial cost-savings.
Jamieson M Bourque; Benjamin H Holland; Denny D Watson; George A Beller
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-31     Completed Date:  2009-09-15     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  538-45     Citation Subset:  AIM; IM    
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MeSH Terms
Exercise Tolerance / physiology*
Metabolic Equivalent*
Middle Aged
Myocardial Ischemia / epidemiology*,  radionuclide imaging*
Predictive Value of Tests
Risk Factors
Tomography, Emission-Computed, Single-Photon
Grant Support
T32 EB003841/EB/NIBIB NIH HHS; T32 EB003841-04/EB/NIBIB NIH HHS; T32 EB003841-05/EB/NIBIB NIH HHS
Comment In:
J Am Coll Cardiol. 2009 Aug 4;54(6):546-8   [PMID:  19643317 ]
J Am Coll Cardiol. 2010 Jan 19;55(3):265-6; author reply 266-7   [PMID:  20117421 ]

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