Document Detail


Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing.
MedLine Citation:
PMID:  25367747     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Previous literature suggests that myocardial perfusion imaging (MPI) adds little to the prognosis of patients who exercise >10 metabolic equivalents (METs) during stress testing. With this in mind, we prospectively tested a provisional injection protocol in emergency department (ED) patients presenting for the evaluation of chest pain in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response.
METHODS: All patients who presented to the ED over a 5-year period who were referred for stress testing as part of their ED evaluation were included. Patients considered for a provisional protocol were: exercise stress, age <65 years, no known coronary artery disease, and an interpretable rest ECG. Criteria for not injecting included a maximal predicted heart rate ≥85 %, ≥10 METs of exercise, no anginal symptoms during stress, and no ECG changes. Groups were compared based on stress test results, all-cause and cardiac mortality, follow-up cardiac testing, subsequent revascularization, and cost.
RESULTS: A total of 965 patients were eligible with 192 undergoing exercise-only and 773 having perfusion imaging. After 41.6 ± 19.6 months of follow-up, all-cause mortality was similar in the exercise-only versus the exercise plus imaging group (2.6 % vs. 2.1 %, p = 0.59). There were no cardiac deaths in the exercise-only group. At 1 year there was no difference in the number of repeat functional stress tests (1.6 % vs. 2.1 %, p = 0.43), fewer angiograms (0 % vs. 4.0 %, p = 0.002), and a significantly lower cost ($65 ± $332 vs $506 ± $1,991, p = 0.002; values are in US dollars) in the exercise-only group. The radiation exposure in the exercise plus imaging group was 8.4 ± 2.1 mSv.
CONCLUSIONS: A provisional injection protocol has a very low mortality, few follow-up diagnostic tests, and lower cost compared to standard imaging protocols. If adopted it would decrease radiation exposure, save time and decrease health-care costs without jeopardizing prognosis.
Authors:
W Lane Duvall; John A Savino; Elliot J Levine; Luke K Hermann; Lori B Croft; Milena J Henzlova
Related Documents :
25260437 - Role of stress echocardiography in operated fallot: feasibility and detection of right ...
15728607 - Mdct of abdominal wall hernias: is there a role for valsalva's maneuver?
25190307 - Low exercise blood pressure and risk of cardiovascular events and all-cause mortality: ...
10461607 - Clinical implication of down-scatter in attenuation-corrected myocardial spect.
18486417 - Failure properties of intraluminal thrombus in abdominal aortic aneurysm under static a...
6965747 - Noninvasive assessment of the effects of aorta-coronary bypass grafting on ventricular ...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-4
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  -     ISSN:  1619-7089     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-4     Completed Date:  -     Revised Date:  2014-11-5    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Ageing, adipose tissue, fatty acids and inflammation.
Next Document:  Nonsurgical giant cell tumour of the tendon sheath or of the diffuse type: Are MRI or (18)F-FDG PET/...