Document Detail

Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction.
MedLine Citation:
PMID:  19152127     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We evaluated the incremental prognostic value of viability assessment by nitrate single-photon emission computed tomography (SPECT) in patients with ischemic left ventricular (LV) dysfunction. METHODS AND RESULTS: One hundred and sixty-four patients with previous myocardial infarction and LV dysfunction (ejection fraction 29% +/- 15%) underwent two Tc-99m sestamibi SPECT studies, under control conditions and after sublingual nitrate administration, for evaluation of myocardial viability. In each patient, viability was defined as the presence of > or = 2 severely dysfunctional segments with preserved tracer uptake (> or = 55% of peak activity). Cardiac death, myocardial infarction, and late (> 2 months) revascularization were considered events. Follow-up was 98% complete at a mean period of 30 +/- 24 months. At baseline SPECT, 119 (73%) patients had evidence of viable myocardium, while 45 (27%) did not. Of these latter patients, 18 (40%) had evidence of viability after nitrate administration. Cardiac events occurred in 58 (35%) patients. Cumulative probability of event-free survival was similar in patients with and without viability at baseline SPECT (log rank 0.3, P = NS), while it was lower in patients with viability at nitrate SPECT compared to those without (log rank 6.3, P < .01). The addition of nitrate SPECT data significantly improved the prognostic power of the model including clinical, functional, angiographic, and baseline SPECT data (P < .01). CONCLUSIONS: In patients with previous myocardial infarction and LV dysfunction, nitrate SPECT imaging provides incremental prognostic information over those obtained from clinical, functional, angiographic variables, and baseline SPECT data.
Laura Evangelista; Wanda Acampa; Mario Petretta; Adele Ferro; Francesca Ricci; Luca Luongo; Stefania Daniele; Giorgio Punzo; Alberto Cuocolo
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Publication Detail:
Type:  Journal Article     Date:  2009-01-20
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  16     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2009 Jan-Feb
Date Detail:
Created Date:  2009-01-19     Completed Date:  2009-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  38-44     Citation Subset:  IM    
SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy.
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MeSH Terms
Italy / epidemiology
Middle Aged
Myocardial Ischemia / mortality*,  radionuclide imaging*
Nitrates / diagnostic use*
Radiopharmaceuticals / diagnostic use
Risk Assessment / methods
Risk Factors
Survival Analysis
Survival Rate
Technetium Tc 99m Sestamibi / diagnostic use*
Tomography, Emission-Computed, Single-Photon / statistics & numerical data*
Ventricular Dysfunction, Left / mortality*,  radionuclide imaging*
Reg. No./Substance:
0/Nitrates; 0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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