Related Experiment Video
Updated: Aug 18, 2026
Dynamic Assessments of Coronary Flow Reserve after Myocardial Ischemia Reperfusion in Mice
Published on: August 25, 2023
Value of pharmacologic stress myocardial perfusion imaging for preoperative risk stratification for aortic surgery
Katsufumi Harafuji1, Taishiro Chikamori, Satoshi Kawaguchi
1Department of Internal Medicine II, Tokyo Medical University, Japan. fwnf8022@mb.infoweb.ne.jp
Insights
Pharmacologic stress SPECT effectively identifies patients at high risk for cardiac events before aortic surgery. Negative SPECT results indicate a safe surgical profile, while positive results necessitate preoperative risk reduction strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Nuclear Cardiology
Background:
- Aortic surgery is a high-risk procedure with a high prevalence of coronary artery disease in patients.
- Preoperative risk stratification is crucial for optimizing outcomes in patients undergoing aortic surgery.
Purpose of the Study:
- To evaluate the utility of pharmacologic stress single-photon emission computed tomography (SPECT) in assessing perioperative cardiac risk before aortic surgery.
Main Methods:
- Pharmacologic thallium SPECT was conducted on 302 patients undergoing aortic surgery (dissection, thoracic aneurysm, abdominal aneurysm).
- Analysis included perfusion defects and the 20-segment model, categorizing SPECT findings as positive or negative.
- Logistic regression identified a summed stress score (SSS) of ≥14 as a key predictor of perioperative cardiac events.
Main Results:
- Pharmacologic SPECT revealed negative findings in 210 patients and positive findings in 92.
- Perioperative cardiac events occurred in 9 patients, with 7 in the positive SPECT group and 2 in the negative SPECT group (p<0.05).
- A summed stress score (SSS) ≥14 was the most significant factor for identifying patients with subsequent perioperative cardiac events.
Conclusions:
- Pharmacologic stress SPECT is valuable for preoperative risk stratification in aortic surgery patients.
- Patients with positive SPECT require aggressive preoperative risk reduction, while those with negative SPECT can undergo surgery safely.
Background:
Aortic surgery is an invasive, high-risk noncardiac procedure and the patients who require it have a high prevalence of coronary artery disease. Therefore, preoperative risk stratification for this subset is essential.
Methods And Results:
To assess the perioperative risk for aortic surgery, pharmacologic stress single-photon emission computed tomography (SPECT) was performed in 302 patients: aortic dissection in 56, thoracic aortic aneurysm in 124, and abdominal aortic aneurysm in 122. Not only was the presence or absence of perfusion defects analyzed, but also the 20-segment model. Pharmacologic thallium SPECT revealed negative findings in 210 patients and positives in 92. Perioperative cardiac events occurred in 9 patients: 7 occurred in patients with positive SPECT, and in only 2 of those with negative SPECT (2/210 vs 7/92; p<0.05). Multivariate analysis using logistic regression model revealed that a summed stress score>or=14 was the most important factor to identify patients who subsequently had perioperative cardiac events.
Conclusions:
Pharmacologic stress SPECT has significant value in the risk stratification of patients before aortic surgery. In patients with positive SPECT, an aggressive approach to reduce the preoperative risk is necessary, whereas aortic surgery can be performed safely in patients with negative SPECT.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Imaging Studies for Cardiovascular System V: CT