| Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role? | |
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MedLine Citation:
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PMID: 19643316 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Jamieson M Bourque; Benjamin H Holland; Denny D Watson; George A Beller |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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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:
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Created Date: 2009-07-31 Completed Date: 2009-09-15 Revised Date: 2010-09-27 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 538-45 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Division and the Cardiovascular Imaging Center, Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA. jamieson2@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Exercise Exercise Tolerance / physiology* Female Humans Male Metabolic Equivalent* Middle Aged Myocardial Ischemia / epidemiology*, radionuclide imaging* Predictive Value of Tests Risk Factors Tomography, Emission-Computed, Single-Photon |
| Grant Support | |
ID/Acronym/Agency:
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T32 EB003841-04/EB/NIBIB NIH HHS; T32 EB003841-05/EB/NIBIB NIH HHS |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2010 Jan 19;55(3):265-6; author reply 266-7
[PMID:
20117421
]
J Am Coll Cardiol. 2009 Aug 4;54(6):546-8 [PMID: 19643317 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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