(Circulation. 1999;99:867-872.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Prognostic Value of Myocardial Perfusion Imaging in Patients With High Exercise Tolerance
From the Department of Radiology, Baylor College of Medicine (S.N.C., W.H.M., P.V.F., R.E.F., R.D.D.), Department of Nuclear Medicine, St. Luke's Episcopal Hospital/Texas Heart Institute (S.N.C., W.H.M., P.V.F., C A.-F., R.D.D.), and Department of Biostatistics and Epidemiology, Texas Heart Institute (V.-V.L.), Houston, Tex.
Correspondence to Sofia Chatziioannou, MD, PhD, St. Luke's Episcopal Hospital MC-3-261, 6720 Bertner Avenue, Houston, TX 77030. E-mail schatziioannou{at}sleh.com
Background—Although high exercise tolerance is associated with an excellent prognosis, the significance of abnormal myocardial perfusion imaging (MPI) in patients with high exercise tolerance has not been established. This study retrospectively compares the utility of MPI and exercise ECG (EECG) in these patients.
Methods and Results—Of 388 consecutive patients who underwent
exercise MPI and reached at least Bruce stage IV, 157 (40.5%) had
abnormal results and 231 (59.5%) had normal results. Follow-up was
performed at 18±2.7 months. Adverse events, including
revascularization, myocardial infarction, and
cardiac death, occurred in 40 patients. Nineteen patients had
revascularization related to the MPI results or the
patient's condition at the time of MPI and were not included in
further analysis. Seventeen patients (12.2%) with abnormal MPI
and 4 (1.7%) with normal MPI had adverse cardiac events
(P<0.001). Cox proportional-hazards regression
analysis showed that MPI was an excellent predictor of cardiac
events (global 
2=13.2; P<0.001; relative
risk=8; 95% CI=3 to 23) but EECG had no predictive power (global
2=0.05; P=0.8; relative risk=1; 95%
CI=0.4 to 3.0). The addition of Duke's treadmill score risk categories
did not improve the predictive power of EECG (global
2=0.17). The predictive power of the combination of EECG
(including Duke score categories) and MPI was no better than that of
MPI alone (global 2=13.5).
Conclusions—Unlike EECG, MPI is an excellent prognostic indicator for adverse cardiac events in patients with known or suspected CAD and high exercise tolerance.
Key Words: perfusion • exercise • electrocardiography • prognosis • radioisotope
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