Prevalence and predictors of automatically quantified myocardial ischemia within a multicenter international registry
Donghee Han1, Alan Rozanski2, Robert J H Miller3
1Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Insights
Cardiac stress testing utility relies on identifying myocardial ischemia. Left ventricular ejection fraction (LVEF) and total perfusion deficit (TPD) strongly predict ischemia prevalence in patients undergoing stress tests.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Cardiac stress testing is crucial for diagnosing myocardial ischemia.
- Understanding ischemia prevalence in patient groups is key to effective testing.
- Previous studies lacked comprehensive analysis of factors influencing ischemia in current patient populations.
Purpose of the Study:
- To comprehensively assess factors predicting myocardial ischemia in patients referred for stress testing.
- To identify the most significant clinical and imaging predictors of ischemia.
- To evaluate the variability of these predictors across different centers.
Main Methods:
- Analysis of 19,690 patients from a multicenter registry undergoing nuclear stress testing.
- Utilized chi-square tests to determine the predictive importance of various patient features.
- Examined clinical data including LVEF, gender, angina type, CAD status, and risk factors.
Main Results:
- Left ventricular ejection fraction (LVEF) and rest total perfusion deficit (TPD) were primary predictors of ischemia.
- Ischemia prevalence significantly increased with lower LVEF and higher TPD.
- Men exhibited a threefold higher frequency of ischemia compared to women (25.8% vs. 8.4%).
Conclusions:
- Myocardial ischemia prevalence is highly variable based on patient characteristics.
- LVEF and rest TPD are identified as robust and consistent predictors of myocardial ischemia.
- Findings emphasize the importance of LVEF and TPD in interpreting stress test results.
Background:
The utility of cardiac stress testing depends on the prevalence of myocardial ischemia within candidate populations. However, a comprehensive assessment of the factors influencing frequency of myocardial ischemia within contemporary populations referred for stress testing has not been performed.
Methods:
We assessed 19,690 patients undergoing nuclear stress testing from a multicenter registry. The chi-square test was used to assess the relative importance of features for predicting myocardial ischemia.
Results:
In the overall cohort, LVEF, male gender, and rest total perfusion deficit (TPD) were the top three predictors of ischemia, followed by CAD status, age, typical angina, and CAD risk factors. Myocardial ischemia was observed in 13.6 % of patients with LVEF > 55 %, in 26.2 % of patients with LVEF 45 %-54 %, and in 48.3% among patients with LVEF < 45 % (P < 0.001). A similar pattern was noted for rest TPD (P < 0.001). Men had a threefold higher frequency of ischemia versus women (25.8 % vs. 8.4%, P < 0.001). Although the relative ranking of ischemia predictors varied among centers, LVEF and/or rest TPD were among the two most potent predictors of myocardial ischemia within each center.
Conclusion:
The prevalence of myocardial ischemia varied markedly according to clinical and imaging characteristics. LVEF and rest TPD are robust predictors of myocardial ischemia.
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