Document Detail

Symptom-limited exercise combined with dipyridamole stress: prognostic value in assessment of known or suspected coronary artery disease by use of gated SPECT imaging.
MedLine Citation:
PMID:  18242479     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Combining vasodilator and exercise stress reduces noncardiac side effects, improves image quality, and enhances the detection of ischemia, compared with suboptimal exercise or vasodilator stress alone. However, prognostic data with combined protocols are limited. METHODS AND RESULTS: Consecutive patients (n = 2064) who underwent symptom-limited exercise and dipyridamole stress with gated single-photon emission computed tomography (SPECT) imaging, without early revascularization, were studied. Subsequent cardiac death or nonfatal myocardial infarction was related to exercise and gated SPECT variables. Cox proportional hazards regression modeling was performed to identify predictors of adverse outcome. Annualized event rates in patients with normal and abnormal images were 0.96% and 2.71%, respectively (P < .001). With abnormal imaging, annualized event rates were 0.86% and 3.13% in patients with average to high and fair or poor functional capacity, respectively (P = .019). Abnormal imaging, a severely reduced post-stress ejection fraction, transient ischemic dilation, and fair or poor functional capacity emerged as predictors of adverse outcome. Accordingly, patients were stratified into low-risk, intermediate-risk, and high-risk cohorts with annualized event rates of 0.94%, 2.24%, and 8.19%, respectively (P < .001 in any two-way comparison). CONCLUSIONS: A protocol that combines symptom-limited exercise and dipyridamole stress with gated SPECT imaging provides highly effective risk stratification for adverse outcomes.
Alan W Ahlberg; Sarkis B Baghdasarian; Haris Athar; Jeffrey P Thompsen; Deborah M Katten; Gavin L Noble; Igor Mamkin; Anuj R Shah; Ivette A Leka; Gary V Heller
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  15     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-02-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  42-56     Citation Subset:  IM    
Nuclear Cardiology Laboratory, Henry Low Heart Center, Division of Cardiology, Hartford Hospital, 80 Seymour St, Hartford, CT 06102, USA.
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MeSH Terms
Aged, 80 and over
Connecticut / epidemiology
Coronary Artery Disease / epidemiology*,  radionuclide imaging*
Dipyridamole / diagnostic use*
Exercise Test / methods*,  statistics & numerical data*
Gated Blood-Pool Imaging / statistics & numerical data*
Image Enhancement / methods
Middle Aged
Tomography, Emission-Computed, Single-Photon / statistics & numerical data*
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole
Comment In:
J Nucl Cardiol. 2008 Jan-Feb;15(1):3-6   [PMID:  18242472 ]

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

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