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THE ADDITIVE DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC VALUE OF SPECT IMAGING OVER EXERCISE ELECTROCARDIOGRAPHY ALONE IN PATIENTS WITH A NORMAL BASELINE ELECTROCARDIOGRAM
A1115 JACC April 1, 2014 Volume 63, Issue 12
Non Invasive Imaging The Additive Diagnostic, Prognostic and Therapeutic Value of SPECT Imaging over Exercise Electrocardiography Alone in Patients with a Normal Baseline Electrocardiogram Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: SPECT Imaging: Focus on Vasodilators, Interpretation and Newer Applications Abstract Category: 16. Non Invasive Imaging: Nuclear Presentation Number: 1173-22 Authors: Saurabh Malhotra, Ravi Sharma, Deepak Kumar Pasupula, Mukul Khanna, Prem Soman, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Background: Guidelines recommend exercise ECG for stress testing in patients with a normal baseline ECG. The additive value of myocardial perfusion SPECT (MPS) in this population remains undefined. Methods: We identified 696 patients with a normal baseline ECG, who underwent an exercise MPS and coronary angiogram (within 6 months of each other). MPS ischemia was defined as a summed difference score (SDS) > 2 and prognostically significant ischemia as a SDS > 8 (>10% ischemic myocardium). Ischemic ECG was defined by standard criteria. Anatomical CAD was defined as >50% diameter stenosis. Pre-test likelihood of CAD was determined by the Diamond-Forester method. Results: The mean exercise time, % predicted heart rate and METs were 9 minutes, 94% and 10, respectively. Anatomical CAD was present in 422 (61%) patients. MPS detected ischemia with greater sensitivity (85% vs 58%) and specificity (82% vs 72%) (figure). Receiver operating chracteristic analysis showed a greater accuracy of MPS for detecting ischemia as compared to exercise ECG in patients with intermediate and high pre-test probability (figure). Among 261 patients who underwent revascularization, 87% had MPS ischemia and only 63%had a positive ECG. Among those with prognostically significant ischemia (n=254), only 64% had a positive ECG. Conclusions: The addition of MPS improves ischemia detection when compared to exercise ECG in patients with normal baseline ECG, and may have a prognostic and therapeutic impact.
Non Invasive Imaging The Additive Diagnostic, Prognostic and Therapeutic Value of SPECT Imaging over Exercise Electrocardiography Alone in Patients with a Normal Baseline Electrocardiogram Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: SPECT Imaging: Focus on Vasodilators, Interpretation and Newer Applications Abstract Category: 16. Non Invasive Imaging: Nuclear Presentation Number: 1173-22 Authors: Saurabh Malhotra, Ravi Sharma, Deepak Kumar Pasupula, Mukul Khanna, Prem Soman, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Background: Guidelines recommend exercise ECG for stress testing in patients with a normal baseline ECG. The additive value of myocardial perfusion SPECT (MPS) in this population remains undefined. Methods: We identified 696 patients with a normal baseline ECG, who underwent an exercise MPS and coronary angiogram (within 6 months of each other). MPS ischemia was defined as a summed difference score (SDS) > 2 and prognostically significant ischemia as a SDS > 8 (>10% ischemic myocardium). Ischemic ECG was defined by standard criteria. Anatomical CAD was defined as >50% diameter stenosis. Pre-test likelihood of CAD was determined by the Diamond-Forester method. Results: The mean exercise time, % predicted heart rate and METs were 9 minutes, 94% and 10, respectively. Anatomical CAD was present in 422 (61%) patients. MPS detected ischemia with greater sensitivity (85% vs 58%) and specificity (82% vs 72%) (figure). Receiver operating chracteristic analysis showed a greater accuracy of MPS for detecting ischemia as compared to exercise ECG in patients with intermediate and high pre-test probability (figure). Among 261 patients who underwent revascularization, 87% had MPS ischemia and only 63%had a positive ECG. Among those with prognostically significant ischemia (n=254), only 64% had a positive ECG. Conclusions: The addition of MPS improves ischemia detection when compared to exercise ECG in patients with normal baseline ECG, and may have a prognostic and therapeutic impact.