Prognostic Value of Normal Stress-Only Technetium-99m Myocardial Perfusion Imaging Protocol

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  • Ueyama Takanao
    Division of Cardiology, Department of Medicine II, Kansai Medical University Division of Cardiology, Department of Medicine II, Kansai Medical University
  • Takehana Kazuya
    Division of Cardiology, Department of Medicine II, Kansai Medical University Division of Cardiology, Department of Medicine II, Kansai Medical University
  • Maeba Hirofumi
    Division of Cardiology, Department of Medicine II, Kansai Medical University Division of Cardiology, Department of Medicine II, Kansai Medical University
  • Iwasaka Toshiji
    Division of Cardiology, Department of Medicine II, Kansai Medical University Division of Cardiology, Department of Medicine II, Kansai Medical University

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タイトル別名
  • – Comparison With Standard Stress-Rest Protocol –

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Background: Patients with a normal stress image on technetium-99m (Tc-99m) single-photon emission computed tomography (SPECT) have a good prognosis for diagnosing coronary artery disease. However, current guidelines recommend stress and rest imaging to confirm that a stress image is normal. Methods and Results: We determined all-cause of cardiac events (acute coronary syndrome and sudden death) in 1,939 patients undergoing stress myocardial perfusion SPECT with Tc-99m radiotracers. Patients with an abnormal stress image were excluded, so we focused on 1,125 patients in whom the stress SPECT study was interpreted as normal. A stress-only protocol was used in 726 patients (adenosine=339; exercise=387), whereas 399 had both stress and rest imaging (adenosine=294; exercise=105). Mean follow-up was 1,252 days. At the end of follow-up, there were 39 cardiac events in the stress-only cohort and 19 in the stress-rest cohort. Kaplan-Meier analysis revealed that there were no differences for the entire cohort of cardiac events not only between the stress-only and stress-rest protocols but also for stressor modality, despite the fact that the stress-rest cohort showed higher coronary risk factors. Conclusions: Patients determined as having a normal SPECT on the basis of stress imaging alone have a similar cardiac event rate as those who have a normal SPECT on the basis of evaluation of both stress and rest images. This imaging strategy will significantly reduce radiation exposure in a substantial number of patients.  (Circ J 2012; 76: 2386–2391)<br>

収録刊行物

  • Circulation Journal

    Circulation Journal 76 (10), 2386-2391, 2012

    一般社団法人 日本循環器学会

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