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Updated: May 22, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Prediction of 9-year cardiovascular outcomes by myocardial perfusion imaging in patients with normal exercise
Arend F L Schinkel1, Henk J Boiten, Jors N van der Sijde
1Department of Cardiology, Erasmus MC, Thoraxcenter, Room Ba304, 's-Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands. a.schinkel@erasmusmc.nl
Insights
Myocardial perfusion imaging (MPI) offers significant long-term prognostic value for patients with normal exercise electrocardiographic testing. This test provides crucial cardiovascular outcome predictions, aiding clinical decision-making.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Exercise myocardial perfusion imaging (MPI) is a common diagnostic tool.
- Its long-term prognostic value in patients with normal exercise electrocardiographic testing (ECT) remains undefined.
Purpose of the Study:
- To define the long-term prognostic value of exercise MPI.
- To assess its utility in patients with normal exercise ECT.
Main Methods:
- 650 patients with suspected coronary artery disease underwent exercise ECT and MPI.
- Outcomes included mortality and major adverse cardiac events (MACE) over a mean 9.2-year follow-up.
- Multivariate analysis identified predictors of outcome using clinical, ECT, and SPECT data.
Main Results:
- 50% of patients had abnormal SPECT results, with 20% showing reversible perfusion defects.
- The summed rest score predicted mortality (HR: 1.15), and the summed stress score predicted MACE (HR: 1.09).
- MPI variables significantly improved prediction of mortality and MACE when added to clinical and ECT data.
Conclusions:
- 20% of patients with normal exercise ECT exhibit reversible myocardial perfusion defects.
- MPI provides incremental prognostic information for 9-year cardiovascular outcomes in this population.
Aims:
Exercise myocardial perfusion imaging (MPI) is widely used, but the long-term prognostic value of this test in patients with normal exercise electrocardiographic testing is not defined.
Methods And Results:
A consecutive group of 650 patients (428 men, mean age: 56 ± 11 years) with known or suspected coronary artery disease underwent exercise electrocardiographic testing and MPI. Follow-up endpoints were mortality and major adverse cardiac events (MACE). Predictors of outcome were identified by multivariate logistic regression analysis using clinical, exercise electrocardiographic testing and single-photon emission computed tomography (SPECT) variables. A total of 324 (50%) patients had an abnormal SPECT, and 131 (20%) had completely or partially reversible perfusion defects. During a mean follow-up of 9.2 ± 2.0 years, 107 (23%) patients died, 69 (11%) had a non-fatal myocardial infarction, 90 (14%) underwent coronary artery bypass surgery, and 142 (22%) percutaneous coronary intervention. Multivariate analysis demonstrated that the summed rest score was an independent predictor of mortality [hazard ratio (HR): 1.15, 95% confidence interval (CI): (1.08-1.22], P < 0.001). The summed stress score was an independent predictor of MACE [HR: 1.09, 95% CI: (1.04-1.13), P < 0.001]. The addition of SPECT variables to clinical and exercise electrocardiographic testing data provided incremental prognostic information for the prediction of mortality and MACE (both P < 0.001).
Conclusion:
Approximately 20% of patients with known or suspected coronary artery disease and normal exercise electrocardiographic testing have completely or partially reversible myocardial perfusion defects. MPI provides additional information for the prediction of 9-year cardiovascular outcomes in these patients.
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