Exercise Echocardiography: A Meta-Analysis The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and (original) (raw)
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The American Journal of Cardiology, 2003
The long-term prognostic value of single-photon emission computed tomography (SPECT) performed late after percutaneous coronary intervention (PCI) has not been extensively evaluated. Moreover, the role of myocardial ischemia at SPECT in symptom-free patients after PCI is not clear. This study was designed to determine the long-term prognostic value of SPECT in predicting cardiac events after PCI in symptomatic and symptom-free patients. Exercise technetium-99m sestamibi SPECT was performed in 206 patients between 12 and 18 months after PCI. All patients were followed for a mean period of 37 ؎ 16 months. Cardiac death, nonfatal myocardial infarction, and late revascularization procedures were considered to be events. Myocardial ischemia at SPECT was detectable in 44 patients. During follow-up, 24 patients experienced events (cardiac death in 4 patients, myocardial infarction in 10, and late revascularization in 10). At univariate analysis, the summed stress score (p <0.05) and summed difference score (p <0.001) were significant predictors of cardiac events. Event-free survival curves showed a higher event rate in patients with than without ischemia (p <0.001). The occurrence of cardiac events was higher in the presence of ischemia at SPECT in symptomatic and symptom-free patients (both p <0.001). The results of this study demonstrate that the extent and severity of myocardial ischemia at exercise SPECT performed between 12 and 18 months after PCI predicts cardiac events during long-term follow-up in symptomatic and symptom-free patients. ᮊ2003 by
Journal of Nuclear Cardiology, 2000
Background Accurate diagnosis of coronary heart disease has the potential to contribute substantially to cost-effective delivery of health services. Recent work by Fleischmann et al (JAMA 1998;280:913-20) represents an effort to summarize the accuracy of exercise echocardiography and exercise single photon emission computed tomography (SPECT). Methods and Results A critique of the previous work was constructed, obtaining the 44 articles used. These articles were reviewed and summarized with established techniques for metaanalysis. The studies summarized by Fleischmann et al were found to be significantly heterogeneous (echocardiography and SPECT, both P < .001). In the SPECT cohort, combination of different radioisotopes and reading techniques, and inclusion of reports using experimental techniques, were sources of heterogeneity. In the echocardiography cohort, experimental techniques and an individual series were identified. When the sample was stratified for sources of heterogeneity, it was found that there was no significant difference in diagnostic accuracy between the echocardiography and SPECT techniques used in current clinical practice. Meta-regression with summary receiver operating characteristic curve techniques, after adjustment of the model for multicolinearity and outliers, revealed that there were no significant differences between SPECT as used in current clinical practice and echocardiography. Conclusion The report by Fleischmann et al contains serious flaws that limit its validity and generalizability.
Journal of Cardiology, 2010
Background: The presence and severity of coronary artery disease may be underestimated in patients who do not reach significant end-points of stress testing during myocardial perfusion imaging. We examined how the effect of the level of exercise may affect the ability of the quantitative gated single-photon emission computed tomography (SPECT) imaging to predict the future cardiac events (cardiac death, non-fatal myocardial infarction and severe heart failure). Method: Of the 4629 consecutively registered patients for J-ACCESS (Japanese-assessment of cardiac event and survival study by quantitative gated SPECT), 2821 patients who underwent the exercise test were selected, and divided into two groups, which reached a target heart rate (group; n = 925) or not (n = 1896). Leg fatigue was the most common reason for stopping the exercise test in non-reaching groups, we conducted a study comparing group with leg fatigue group (group II). Results: During a 3-year follow-up period, total of 25 cardiac events (2.7%) occurred in group I and total of 73 events (3.9%) occurred in group II. The incidence of cardiac death was slightly
Journal of the American College of Cardiology, 2015
Background: Guidelines recommend exercise electrocardiography (ECG) for patients with a normal baseline ECG referred for diagnostic stress testing. The additive value of myocardial perfusion Single-Photon Emission Computed Tomography (MPS) for ischemia detection, and its prognostic impact in this population remain undefined. methods: We identified 7394 patients with a normal baseline ECG, who underwent an exercise MPS between January 2003 and December 2011. MPS ischemia was defined as a summed difference score (SDS) > 2. Standard criteria were used to define an ischemic ECG response. Social security death index was used to determine all-cause mortality. results: Ischemic ECG was present in 1775 (24%) and MPS ischemia was present in 803 (11%) of the patients. MPS ischemia was absent in 77% of those with a positive ECG, while MPS ischemia was present in only 7% of the patients with a negative ECG. During an average follow up time of 7 years, there were 353 deaths (4.8%). The mortality was greater among those with MPS ischemia as compared to those ECG ischemia (Figure A). Survival analysis showed a significantly worse long-term survival with MPS ischemia (Figure B). On Cox regression MPS ischemia was a significant predictor of mortality (HR, 95% CI: 2.0, 1.5-2.6) whereas ECG ischemia was not (HR, 95% CI: 1.2, 0.9-1.5). conclusion: Addition of MPS, in patients with normal baseline ECG, adds to the specificity of ischemia detection. MPS ischemia is a more powerful predictor of long-term mortality.
Role of Exercise Echocardiography to Predict Coronary Artery Disease
University Heart Journal, 2021
Background: Coronary artery disease (CAD) is predicted to be the most common cause of death globally. Early detection of coronary artery disease and adequate management can reduce CAD related morbidity and mortality. Various non-invasive procedures have been developed to diagnose CAD. Stress echocardiography, myocardial perfusion (SPECT) and cardiac MRI are accepted as useful tools for evaluation of inducible myocardial ischaemia in intermediate risk group patient documented by pre test probability. Among them exercise echocardiography is a remarkable physiological, safe, feasible and cost effective. Objective: To see the role of exercise echocardiography to predict CAD. Materials and methods: This cross sectional study was conducted in University Cardiac Center (UCC), BSMMU. This study include the patients who are appointed for exercise tolerance test (ETT). Echocardiographic wall motion study was recorded at rest and after peak exercise and analyzed to diagnosis the regional wall ...