Journal of nuclear medicine : official publication, Society of Nuclear Medicine · 2011
Improved outcome prediction by SPECT myocardial perfusion imaging after CT attenuation correction.
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Pazhenkottil Aju P, Ghadri Jelena-Rima, Nkoulou Rene N, Wolfrum Mathias, Buechel Ronny R, Küest Silke M, Husmann Lars, Herzog Bernhard A, Gaemperli Oliver, Kaufmann Philipp A
Аннотация
UNLABELLED: The aim of this study was to determine the impact of attenuation correction with CT (CT-AC) on the prognostic value of SPECT myocardial perfusion imaging (SPECT MPI).
METHODS: The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress-rest (99m)Tc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan-Meier analysis.
RESULTS: At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0-3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4-8 (4.3%), with increased MACE rate, and an SSS of 9-13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1-3 (3.7%), with a plateau at an SSS of 4-8 (3.2%).
CONCLUSION: CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.
METHODS: The summed stress score (SSS; 20-segment model) was obtained from filtered backprojection (FBP) and iterative reconstruction with CT-AC in 876 consecutive patients undergoing a 1-d stress-rest (99m)Tc-tetrofosmin SPECT MPI study for the evaluation of known or suspected coronary artery disease. Survival free of major adverse cardiac events (MACEs; cardiac death or nonfatal myocardial infarction) and survival free of any adverse cardiac events (including cardiac hospitalization, unstable angina, and late coronary revascularization) were analyzed by Kaplan-Meier analysis.
RESULTS: At a mean follow-up of 2.3 ± 0.6 y, a total of 184 adverse events occurred in 145 patients, including 35 MACEs (16 cardiac deaths [rate, 1.8%] and 19 nonfatal myocardial infarctions [rate, 2.2%]). With FBP, an SSS of 0-3 best distinguished patients with a low MACE rate (0.6%), followed by an SSS of 4-8 (4.3%), with increased MACE rate, and an SSS of 9-13 (3.8%), which was comparable. By contrast, with CT-AC the discrimination of low from intermediate MACE rate was best observed between an SSS of 0 (0%) and an SSS of 1-3 (3.7%), with a plateau at an SSS of 4-8 (3.2%).
CONCLUSION: CT-AC for SPECT MPI allows improved risk stratification. The prognostically relevant SSS cutoff is shifted toward lower values.
Предметные рубрики MeSH
AdenosineAgedDeath, Sudden, CardiacDisease-Free SurvivalElectrocardiographyEndpoint DeterminationFemaleFollow-Up StudiesHeartHeart DiseasesHumansImage Interpretation, Computer-AssistedKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionMyocardial Perfusion ImagingOrganophosphorus CompoundsOrganotechnetium CompoundsPredictive Value of TestsPrognosisRadiopharmaceuticalsRisk FactorsTomography, Emission-ComputedTomography, Emission-Computed, Single-PhotonTreatment Outcome