2012, Number 1
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Gac Med Mex 2012; 148 (1)
Evaluación de la perfusión miocárdica con tomografía computarizada por emisión de fotones individuales (SPECT) cardíaco: utilidad del protocolo sólo-estrés
Vallejo E, Acevedo C, Varela S, Alburez JC, Bialostozky D
Language: Spanish
References: 29
Page: 6-13
PDF size: 94.71 Kb.
ABSTRACT
Single photon emission computed tomography (SPECT) myocardial perfusion imaging is widely used for diagnosing coronary artery disease (CAD). However, SPECT costs, imaging time, and radiation exposure, limit SPECT indications.
Objective: Determine whether a stress-only SPECT imaging would be enough to obtain a diagnosis of CAD improving nuclear laboratory efficiency.
Methods: 122 patients with unknown CAD were evaluated with stress-only SPECT imaging. In order to evaluate diagnostic accuracy and the prognostic value of the stress-only protocol, patients with abnormal SPECT underwent invasive angiography and patients with normal SPECT were followed-up during 3 years.
Results: Diagnosis time, SPECT cost, and radiopharmaceutical dosage were significantly lower as compared with the conventional SPECT imaging protocol (30, 40 and 55%, respectively). Diagnostic accuracy and cardiac prognosis information were comparable to those obtained with the conventional imaging protocol (positive predictive value for CAD of 85% and negative predictive value for cardiac events of 97%).
Conclusions: In patients with intermediate risk for CAD, stress-only SPECT imaging will significantly improve nuclear laboratory efficiency, and with similar accuracy than that the one obtained with the conventional protocol.
REFERENCES
Salerno M, Beller GA. Noninvasive assessment of myocardial perfusion. Circ Cardiovasc Imaging. 2009;2:412-24.
Camici PG, Rimoldi OE. The clinical value of myocardial blood measurement. J Nucl Med. 2009;50:1076-87.
Des Press RD, Shaw LJ, Gillespie RL, et al. Cost-effectiveness of myocardial perfusion imaging: A summary of the currently available literature. J Nucl Cardiol. 2005;12:750-9.
Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results form the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283-91.
Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900-7.
Johansen A, Hoilund-Carlsen PF, Christiansen HW, Vach W, Moldrup M, Haghfelt T. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularization in patients with stable angina pectoris. Eur J Nuc Med Mol Imaging. 2005;32:1363-70.
Hendel RC, Berman DS, DiCarli MF, et al. ACCF/ASNC/ACR/AHA/ASE/ SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. J Am Coll Cardiol. 2009;53:2201-29.
Vallejo E. Optimización de los recursos en cardiología nuclear. Arch Cardiol Mex. 2001;73:S148-50.
Hansen CL, Goldstein RA. Myocardial perfusion and function: Single photon emission computed tomography. ASNC Guidelines for Nuclear Cardiology Procedures. J Nucl Cardiol. 2007;14:e39-60.
American Society of Nuclear Cardiology. Imaging guidelines for nuclear cardiology procedures. J Nucl Cardiol. 2006;13:e25-41.
Henzlova M, Cerqueira M, Mahmarian J, Yao S. Stress protocols and tracers. En: DePuey EG, ed. Imaging guidelines for nuclear cardiology procedures: a report from the nuclear cardiology quality assurance committee. American Society of Nuclear Cardiology; 2006.p. 171.
Matsuo S, Watanabe S, Kadosaki T, et al. Validation of collateral fractional flow reserve by myocardial perfusion imaging. Circulation. 2002;105:1060-5.
Hachamovitch R, Hayes S, Friedman JD, et al. Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: what is the warranty period of a normal scan? J Am Coll Cardiol. 2003;41:1329-40.
Gibson PB, Demus D, Noto R, Hudson W, Johnson LL. Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. J Am Coll Cardiol. 2002;39:999-1004.
Diamond DA, Forrester JS. Analysis of probability as an aid in the clinical decisions of coronary artery disease. N Eng J Med. 1979;300: 1350-6.
Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training. A statement for healthcare professional from the American Heart Association. Circulation. 2001;104:1694-740.
Massood Y, Liu YH, DePuey G, et al. Clinical validation of SPECT attenuation correction using x-ray computed tomography-derived attenuation maps: Multicenter clinical trial with angiographic correlation. J Nucl Cardiol. 2005;6:676-86.
American Heart Association writing group on myocardial segmentation and registration for cardiac imaging. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professional from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation. 2002;105:539-42.
Berman DS, Abidov A, Kan X, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol. 2004;11:414-23.
Vallejo E, Dione DP, Sinusas AJ, Wackers FJ. Assessment of left ventricular ejection fraction with quantitative gated SPECT: accuracy and correlation with first-pass radionuclide angiography. J Nucl Cardiol. 2000;7:461-70.
Fazel R, Krumholz HM, Wang W. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849-57.
Chang SM, Nabi F, Xu J, Raza U, Mahmarian JJ. Normal stress-only versus standard stress/rest myocardial perfusion imaging. J Am Coll Cardiol. 2010;55:221-30.
Hausleeiter J, Meye T, Hermann F, et al. Estimated dose associated with cardiac CT angiography. JAMA. 2009;301:500-7.
Beller GA. Importance of consideration of radiation doses from cardiac imaging procedures and risks of cancer. J Nucl Cardiol. 2010;17:1-3.
Shaw LJ, Hachamovitch R, Heller GV, et al. Noninvasive strategies for the estimation of cardiac risk in stable chest pain patients. The Economics of Noninvasive Diagnosis (END) Study Group. Am J Cardiol. 2000; 6:1-7.
Shaw LJ, Heller GV, Travin MI, et al. Cost analysis of diagnostic testing for coronary artery disease in women with stable chest pain. Economics of Noninvasive Diagnosis (END) Study Group. J Nucl Cardiol. 1999;6: 559-69.
Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;6:535-43.
Bestetti A, Di Leo C, Alessi A, Triulzi A, Tagliabue L, Tarolo GL. Poststress en-systolic left ventricular dilation: a marker of endocardial postischemic stunning. Nucl Med Commun. 2001;22:685-93.
Berman DS, Kang, X, Slomka PJ, Germano G, Hachamovitch R. Underestimation of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol. 2007; 14:521-8.