Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2025
Accuracy of myocardial perfusion imaging in older patients: Insights from a sub-analysis of the AMICO registry.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Liga Riccardo, Filidei Elena, Runza Giusi, Gimelli Alessia
Аннотация
BACKGROUND: To assess the accuracy of myocardial perfusion imaging (MPI) on a cadmium-zinc-telluride camera in detecting coronary artery disease (CAD) and predicting prognosis in older patients.
METHODS: Six hundred and twenty-seven older patients (aged >70 years) and the same number of matched controls were submitted to exercise or vasodilator-stress MPI and coronary angiography. The rate-pressure product (RPP) reserve (stress/rest) was computed as a measure of cardiac workload during exercise. Ischemia was defined as a summed difference score (SDS) >3. Coronary stenoses >70% were considered obstructive. Patients were followed (mean 4.1 ± 2.4 years) for a composite of cardiovascular death, nonfatal myocardial infarction, and urgent revascularization (MACE).
RESULTS: Obstructive CAD was revealed in 426/627 patients (68%) and 410/627 controls (65%). While in the overall population MPI showed a significant accuracy for detecting obstructive CAD (AUC: .79, 95% confidence interval [CI]: .77-.82; P < .001), test accuracy seemed to decrease with older age, with older patients showing lower specificity than controls (72% vs 64%, respectively; P = .002). This difference was exclusively limited to patients undergoing exercise-stress, whereby the overall test accuracy was significantly lower in older patients than controls (AUC: .82 vs .75; P = .03). Older patients attained a significantly lower peak workload (101 ± 26 W vs 111 ± 34 W; P < .001) and RPP reserve during exercise than controls (1.9 ± .9 vs 2.2 ± .7, P < .001), resulting in an independent predictor of reduced diagnostic specificity (odds ratio: .68, 95% CI: .50-.96; P = .027). At multivariable Cox regression analysis, a higher SDS was an independent predictor of major adverse cardiac events (MACE) (HR 1.11, 95% CI: 1.07-1.14; P < .001).
CONCLUSIONS: In older patients, exercise-stress MPI shows a lower diagnostic accuracy than in controls because of an impaired exercise capacity.
METHODS: Six hundred and twenty-seven older patients (aged >70 years) and the same number of matched controls were submitted to exercise or vasodilator-stress MPI and coronary angiography. The rate-pressure product (RPP) reserve (stress/rest) was computed as a measure of cardiac workload during exercise. Ischemia was defined as a summed difference score (SDS) >3. Coronary stenoses >70% were considered obstructive. Patients were followed (mean 4.1 ± 2.4 years) for a composite of cardiovascular death, nonfatal myocardial infarction, and urgent revascularization (MACE).
RESULTS: Obstructive CAD was revealed in 426/627 patients (68%) and 410/627 controls (65%). While in the overall population MPI showed a significant accuracy for detecting obstructive CAD (AUC: .79, 95% confidence interval [CI]: .77-.82; P < .001), test accuracy seemed to decrease with older age, with older patients showing lower specificity than controls (72% vs 64%, respectively; P = .002). This difference was exclusively limited to patients undergoing exercise-stress, whereby the overall test accuracy was significantly lower in older patients than controls (AUC: .82 vs .75; P = .03). Older patients attained a significantly lower peak workload (101 ± 26 W vs 111 ± 34 W; P < .001) and RPP reserve during exercise than controls (1.9 ± .9 vs 2.2 ± .7, P < .001), resulting in an independent predictor of reduced diagnostic specificity (odds ratio: .68, 95% CI: .50-.96; P = .027). At multivariable Cox regression analysis, a higher SDS was an independent predictor of major adverse cardiac events (MACE) (HR 1.11, 95% CI: 1.07-1.14; P < .001).
CONCLUSIONS: In older patients, exercise-stress MPI shows a lower diagnostic accuracy than in controls because of an impaired exercise capacity.