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Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular

Guillermo Romero-Farina1, Jaume Candell-Riera, Santiago Aguadé-Bruix

  • 1Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain. guirom@adinet.com.uy

European Journal of Nuclear Medicine and Molecular Imaging
|May 16, 2013
PubMed

Insights

Older age, diabetes, and left bundle branch block predict cardiac events in patients with normal SPECT scans. Known coronary artery disease or a positive stress test increase the need for revascularization.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Diagnostic Imaging

Background:

  • Assessing risk in patients with normal stress-rest gated SPECT is crucial.
  • Identifying predictors for hard cardiac events (HE) and coronary revascularization (CR) is essential for patient management.

Purpose of the Study:

  • To determine the impact of clinical, electrocardiographic, and stress testing variables on predicting HE and CR.
  • To identify independent predictors of HE and CR in patients with normal gated SPECT findings.

Main Methods:

  • Analysis of 2,004 patients with normal myocardial perfusion and LVEF >50% on gated SPECT.
  • Follow-up for hard cardiac events (cardiovascular death or acute myocardial infarction) and coronary revascularization.
  • Univariate and independent predictor analysis of clinical and stress testing variables.

Main Results:

  • Independent predictors of HE included age ≥65 years, insulin-dependent diabetes mellitus (IDDM), and left bundle branch block (LBBB).
  • Independent predictors of CR included known coronary artery disease (CAD) and a positive stress test.
  • Low event rates observed: 1.6% for HE and 2.5% for CR over 4.3 years.

Conclusions:

  • Age, IDDM, and LBBB are independent predictors of hard cardiac events in patients with normal SPECT.
  • Known CAD and positive stress tests significantly increase the likelihood of coronary revascularization.
  • Gated SPECT findings of normal perfusion and LVEF do not eliminate long-term cardiac event risk.
Abstract

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