Exercise Echocardiography: A Meta-Analysis The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and (original) (raw)
iranian journal of nuclear medicine, 2014
Introduction: Good functional capacity has a high negative predictive value (NPV) in patients with known or suspected coronary artery disease (CAD) similar to a normal gated myocardial perfusion imaging (GMPI). Aim of this study was to evaluate NPV of functional capacity during treadmill exercise in patients with normal GMPI in Pakistani population. Methods: This was a prospective study which included 1318 individuals with normal exercise GMPI. On the basis of maximal age predicted heart rate (MAPHR) and metabolic equivalents (METS) achieved, these patient were divided into Group A: ≥ 85% MAPHR and ≥7 METS (714 patients), Group B: ≥85% MAPHR and <7METS (145 patients), Group C: <85% MAPHR and ≥7 METS (289 patients) and Group D: <85% MAPHR and <7 METS (170 patients). Patients were followed up on telephone (15 ±3 months) for fatal or non-fatal myocardial infarction (FMI and NFMI). Results: There was no MI in any group but NFMIs was reported in 2.07% in Group B and 2.35% in ...
Journal of the American College of Cardiology, 1984
Exercise thallium-201 perfusion scans and gated equilibrium blood pool scans were performed in 120 catheterized patients with a chest pain syndrome. Eighty-six patients had coronary artery disease and 34 patients did not. The effects of gender, propranolol, exercise level, exercise ischemia, history of typical angina, history of previous myocardial infarction, electrocardiographic Q waves, number of diseased vesselsand extent of coronary artery obstruction on diagnostic accuracy were evaluated. The overall sensitivity and specificity of thallium scans were 76 and 68%, respectively, and those of gated blood pool scans 80 and 62% (p = not significant). Propranolol decreased the specificity of thallium scans (propranolol = 42%; no propranolol = 87%, P < 0.05).
The American Journal of Cardiology, 2001
The exercise electrocardiogram (ECG) is widely believed to be less accurate in women, primarily due to a high prevalence of false-positive tests. The purpose of this study was to examine the relative accuracy of the exercise ECG in women versus men in 8,671 patients (3,213 women, 5,458 men) using myocardial perfusion imaging as the reference standard. More women (14%) than men (10%) had a false-positive ECG (p <0.001), but the absolute difference was relatively small. The false-negative rate was considerably lower in women (17% vs 32%, p <0.001). Compared with men, women had lower test sensitivity (30% vs 42%, p <0.001) and positive predictive value (34% vs 70%, p <0.001) but higher specificity (82% vs 78%, p ؍ 0.002), negative predictive value (78% vs 52%, p <0.001), and accuracy (69% vs 58%, p <0.001). In patients with a false-negative exer-cise ECG, "high-risk" scans were less prevalent in women (12% vs 19%, p <0.001). In the smaller subset of patients referred for coronary angiography (205 women, 838 men), the false-positive electrocardiographic rate was again higher in women (13% vs 7%, p ؍ 0.003), but neither specificity (69% vs 74%, p ؍ NS) nor accuracy (60% vs 66%, p ؍ NS) was different between the sexes. Thus, the percentage of patients with a false-positive exercise ECG was higher in women than men but low in absolute terms (<15%) for both sexes. Test specificity was not lower in women. These results suggest that gender should not be a major determinant for selecting stress imaging over standard treadmill testing.
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 ...
PURPOSE: Reversible ischaemia at radionuclide myocardial perfusion imaging (MPI) accurately predicts risk of cardiac death and nonfatal myocardial infarction (major adverse cardiac events, MACE). This prognostic penetrance might be empowered by accounting for exercise tolerance as an indirect index of ischaemia severity. The present study aimed to verify this hypothesis integrating imaging assessment of ischaemia severity with exercise maximal rate pressure product (RPP) in a large cohort of patients with suspected or known coronary artery disease (CAD). METHODS AND RESULTS: We analysed 1,502 consecutive patients (1,014 men aged 59 ± 10 years) submitted to exercise stress/rest MPI. To account for exercise tolerance, the summed difference score (SDS) was divided by RPP at tracer injection providing a clinical prognostic index (CPI). Reversible ischaemia was documented in 357 patients (24 %) and was classified by SDS as mild (SDS 2-4) in 180, moderate (SDS 5-7) in 118 and severe (SDS >7) in 59. CPI values of ischaemic patients were clustered into tertiles with lowest and highest values indicating low and high risk, respectively. CPI modified SDS risk prediction in 119/357 (33 %) patients. During a 60-month follow-up, MACE occurred in 68 patients. Kaplan-Meier analysis revealed that CPI significantly improved predictive power for MACE incidence with respect to SDS alone. Multivariate Cox analysis confirmed the additive independent value of CPI-derived information. CONCLUSION: Integration of ischaemic threshold and ischaemia extension and severity can improve accuracy of exercise MPI in predicting long-term outcome in a large cohort of patients with suspected or known CAD.
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
Utility of myocardial perfusion imaging in patients with low-risk treadmill scores
Journal of the American College of Cardiology, 2004
The purpose of this study was to determine whether a previously validated clinical score (CS) could identify patients with a low-risk Duke treadmill score who had a higher risk of adverse events and, therefore, in whom myocardial perfusion imaging would be valuable for risk stratification. BACKGROUND Current American College of Cardiology/American Heart Association guidelines recommend using a standard exercise test without imaging as the initial test in patients who have an interpretable electrocardiogram and are able to exercise.
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2017
The diagnostic yield of combined cardiopulmonary exercise testing (CPET) and myocardial perfusion imaging (MPI) in patients referred for stress testing has received limited study. We evaluated consecutive patients who underwent combined CPET-MPI at a single tertiary referral center between 2011 and 2015. An abnormal CPET was defined as any of the following: reduced oxygen consumption, cardiac output impairment, or pulmonary impairment. Normal MPI was defined as the absence of resting or stress perfusion defect. The primary study outcome was change in clinical decision-making after CPET-MPI including management of pulmonary disease, management of deconditioning, heart failure management, and referral for cardiac catheterization. Outcomes of patients with normal and abnormal MPI were presented based on the specific CPET abnormality. 415 patients were included in the study. Of the 269 patients that had normal MPI, 206 (77%) had abnormal CPET. Patients with abnormal CPET and normal MPI,...