Related Experiment Video
Updated: Aug 22, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission
Aiden Abidov1, Rory Hachamovitch, Alan Rozanski
1Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Insights
Atrial fibrillation (AF) independently increases cardiac death risk in patients undergoing myocardial perfusion imaging. Even with mildly abnormal scans, AF patients face higher risks, suggesting closer monitoring or earlier intervention may be needed.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiac Imaging
Background:
- The prognostic impact of atrial fibrillation (AF) in patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) is not well-established.
- Understanding AF's role is crucial for risk stratification in cardiac patients.
Purpose of the Study:
- To assess if the presence of atrial fibrillation (AF) offers additional prognostic information beyond myocardial perfusion imaging (MPI) for predicting cardiac death (CD).
- To evaluate the incremental prognostic value of AF in patients undergoing MPS.
Main Methods:
- A cohort of 16,048 patients undergoing MPS was followed for cardiac death (CD).
- Cox proportional hazards models were used to analyze clinical and perfusion data, comparing patients with and without AF.
- Multivariable analysis adjusted for established risk factors for CD.
Main Results:
- Atrial fibrillation (AF) was a significant predictor of cardiac death (CD) across all MPS categories: normal, mildly abnormal, and severely abnormal.
- AF patients exhibited worse survival rates (p = 0.001) even after adjusting for key predictors.
- In patients with gated MPS, AF provided incremental prognostic value over clinical, nuclear variables, and left ventricular ejection fraction (p = 0.014).
Conclusions:
- Atrial fibrillation (AF) independently elevates the risk of cardiac events, including cardiac death (CD), beyond perfusion and function data in MPS patients.
- Patients with AF face a high risk of CD, even with minimally abnormal MPS results.
- Further research is needed to determine if AF patients with mildly abnormal MPS warrant earlier cardiac catheterization referral.
Objectives:
The aim of this research was to determine whether presence of atrial fibrillation (AF) provides incremental prognostic information relative to myocardial perfusion single-photon emission computed tomography (MPS) with respect to risk of cardiac death (CD).
Background:
The prognostic significance of AF in patients undergoing MPS is not known.
Methods:
A total of 16,048 consecutive patients undergoing MPS were followed-up for a mean of 2.21 +/- 1.15 years for the development of CD. Of those, 384 patients (2.4%) had AF. Cox proportional hazards method was used to compare clinical and perfusion data for the prediction of CD in patients with and without AF.
Results:
Atrial fibrillation was a significant predictor of CD in patients with normal (1.6% per year vs. 0.4% per year in non-AF patients), mildly abnormal (6.3% per year vs. 1.2% per year), and severely abnormal MPS (6.4% per year vs. 3.7% per year) (p < 0.001 for all). By multivariable analysis, AF patients had worse survival (p = 0.001) even after adjustment for the variables most predictive of CD: age, diabetes, shortness of breath, use of vasodilator stress, rest heart rate, and the nuclear variables. In the 4,239 patients with left ventricular ejection fraction evaluated by gated MPS, AF demonstrated incremental prognostic value not only over clinical and nuclear variables, but also over left ventricular ejection in predicting CD (p = 0.014).
Conclusions:
The presence of AF independently increases the risk of cardiac events over perfusion and function variables in patients undergoing MPS. Patients with AF have a high risk of CD, even when MPS is only mildly abnormal. Whether patients with AF and mildly abnormal MPS constitute a group more deserving of early referral to cardiac catheterization is a question warranting further study.
