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Enhanced prognostic stratification of patients with left ventricular hypertrophy with the use of single-photon
A M Amanullah1, D S Berman, X Kang
1Departments of Medicine (Division of Cardiology) and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Insights
Myocardial perfusion SPECT effectively risk-stratifies patients with left ventricular hypertrophy (LVH), identifying those at high risk for cardiovascular events. This imaging technique adds crucial prognostic information beyond traditional clinical factors.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Left ventricular hypertrophy (LVH) is associated with increased cardiovascular event risk.
- Prognostic stratification in LVH patients using myocardial perfusion imaging is not well-established.
Purpose of the Study:
- To evaluate the prognostic value of myocardial perfusion single-photon emission computed tomography (SPECT) for risk stratification in patients with LVH.
Main Methods:
- A cohort of 633 patients with electrocardiographic LVH underwent dual-isotope myocardial perfusion SPECT.
- Patients were followed for a mean of 22 months for major adverse cardiac events (cardiac death, nonfatal myocardial infarction).
Main Results:
- The annual event rate was 6%, with significant risk stratification based on SPECT results.
- Normal scans showed a low event rate (<1%), while abnormal scans had rates of 4.9% (mildly abnormal) and 10.3% (moderately to severely abnormal).
- Summed stress score on SPECT provided significant incremental prognostic information beyond clinical variables.
Conclusions:
- SPECT enhances prognostic stratification in LVH patients with high event rates.
- Myocardial perfusion SPECT adds significant prognostic value beyond clinical and historical data for LVH patients.
Background:
Patients with left ventricular hypertrophy (LVH) are at increased risk of future cardiovascular events. Little is known about risk stratification of these patients with the use of myocardial perfusion imaging. This study sought to assess the prognostic stratification of patients with LVH by using myocardial perfusion single-photon emission computed tomography (SPECT).
Methods And Results:
We studied 633 consecutive patients with electrocardiographic evidence of LVH who underwent dual isotope myocardial perfusion SPECT (rest thallium 201/stress technetium 99m sestamibi) and were followed up for a mean period of 22 +/- 7 months. During the follow-up period, 67 events (35 cardiac deaths and 32 nonfatal myocardial infarctions) occurred (6% annual event rate). The results of the perfusion scan significantly risk-stratified the population; patients with normal scans had a low rate of nonfatal myocardial infarction and cardiac death (<1% per year of follow-up). The rates of cardiac events increased significantly as a function of the scan result: 4.9% in patients with mildly abnormal scans and 10. 3% in moderately to severely abnormal scans. Cox proportional hazards analysis demonstrated that after adjusting for pretest likelihood of coronary artery disease (the most predictive clinical variable; chi(2) = 15.5, P <.001), summed stress score (the most predictive nuclear variable; chi(2) = 18, P <.0001) added significant incremental prognostic information (global chi(2) increased from 15.5 to 36; P <.001).
Conclusions:
In patients with LVH with an overall high cardiac event rate, SPECT provided enhanced stratification by adding significant incremental prognostic information over clinical and historic variables.