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Higher event rate in patients with high-risk Duke Treadmill Score despite normal exercise-gated myocardial perfusion

Maseeh Uz Zaman1,2, Nosheen Fatima1,2, Areeba Zaman3

  • 1Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan.

World Journal of Nuclear Medicine
|July 24, 2018
PubMed

Insights

Patients with normal myocardial perfusion imaging (MPI) and low-risk Duke Treadmill Scores (DTS) have low risk of nonfatal myocardial infarction (NFMI). High-risk DTS indicates elevated NFMI risk, even with normal MPI.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Medicine

Background:

  • Myocardial perfusion imaging (MPI) assesses heart function.
  • Duke Treadmill Score (DTS) stratifies cardiac risk.
  • Predictive value of DTS in normal MPI is unclear.

Purpose of the Study:

  • To determine the negative predictive value of DTS in patients with normal MPI.
  • To evaluate the association between DTS risk categories and adverse cardiac events.

Main Methods:

  • Prospective study of 583 patients with normal exercise MPI.
  • Patients stratified into low, intermediate, and high-risk DTS groups.
  • Follow-up for 2 years for fatal and nonfatal myocardial infarction (NFMI).

Main Results:

  • High-risk DTS patients were older, with higher BMI and male preponderance.
  • No significant differences in risk factors or ejection fraction across groups.
  • High-risk DTS was associated with significantly higher NFMI events (P=0.0001).
  • Low-to-intermediate risk DTS showed significantly low NFMI rates.

Conclusions:

  • Low-to-intermediate risk DTS predicts low NFMI in normal MPI patients.
  • High-risk DTS identifies elevated NFMI risk despite normal MPI.
  • Further studies needed to validate DTS predictive value for ST deviations in normal MPI.

Keywords:
Duke Treadmill Scoreexercise testingmyocardial perfusion imagingnonfatal cardiac eventprognosis

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