5.6Myocardial perfusion and endothelial function in women with angina and normal coronary angiograms (original) (raw)

2007, Journal of Nuclear Cardiology

Background: Cardiovascular events increased as the glomerular filtration rate (GFR) declined. Early diagnosis of CVD by myocardial perfusion imaging (MPI), might have an important impact on long-term outcomes. The aim of this study was to evaluate the prognostic value of MPI in pts with decreased GFR. Methods: The study population consisted of 137 pts that underwent a stressredistribution Tl-201 SPECT MPI and had an estimated GFR of less than 60 ml/min (mean eGFR was 26.3Ϯ16.4 mg/dl). MPI was visually assessed and defined normal or abnormal MPI by the presence thallium defects either fixed, reversible or combined. The follow up period was 18 month minimum after nuclear testing. Cardiac events (CE) were classified as hard events (HE), defined as either cardiac death or nonfatal myocardial infarction and soft events (SE) as coronary revascularization (PCI or CABG) or unstable angina hospitalization. Comparison between patient groups with and without CE was assessed by use of the chi-square test. Results: The mean age patient population was 67.4Ϯ9.6 years old, 100 of the pts (73%) were male. Normal MPI was present in 42(30.7%) of the pts. During the follow-up period, 47 (34.3%) pts developed CE (HE ϭ22and SEϭ25). In comparison with those that did not have any CE, they were significantly older and had more often a previous history of CAD (70.2 vs 38.9%, pϭ 0.0005). No significant differences were observed between the two groups regarding: gender, incidence of risk factors (hypertension, diabetes, hypercholesterolemia, smoking), PVD, resting ECG. However, a significant difference in MPI results was present between the groups, 45 (95.7%) of the 47 pts that developed a CE showed an abnormal MPI, in contrast to only 2 (4.3%) with a normal MPI, pϽ 0.0001. Moreover, none of the 22 pts that develop a HE had a normal MPI. While, 50 pts (55.6%) without any CE showed an abnormal MPI. Resulting in a negative and positive predictive value of 95.2% and 47.4%, respectively. Conclusions: In patients with decreased estimated glomerular filtration rate, a normal stress MPI indicates a low risk patient group. However, MPI abnomality confers a poor prognosis. Stress Tl-201 SPECT MPI significantly improves the risk stratification in this high risk population.