OBJECTIVES: The purpose of this study was to assess the relationship between b ody mass index(BMI) and the prognostic value of myocardial perfusion single-pho ton emission computed tomography(MPS). BACKGROUND: The pro...OBJECTIVES: The purpose of this study was to assess the relationship between b ody mass index(BMI) and the prognostic value of myocardial perfusion single-pho ton emission computed tomography(MPS). BACKGROUND: The prognostic value of MPS i n the obese has not been evaluated. METHODS: We studied 4,720 patients with and 10,019 patients without known coronary artery disease(CAD) who underwent rest Tl -201/stress Tc-99m sestamibi MPS, including 5,233 gated MPS studies and follow ed up(mean 2.7 to 3.2 years). Patients were categorized as normal weight(BMI 18. 5 to 24.9 kg/m2), overweight(BMI 25.0 to 29.9 kg/m2), or obese(BMI<30.0 kg/m2). RESULTS: Unadjusted annual rates of cardiac death(CD) rose versus stress MPS abn ormalities in all weight groups(p< 0.001). Obese or overweight patients with or without known CAD who had normal MPS were at low CD risk(< 1%/year), similar to normal weight patients. In CAD, obese and overweight patients with abnormal MPS had lower rates of CD compared with normal weight patients(p< 0.01). In patient s with low ejection fraction(EF) by gated MPS, those with normal weight had high est CD rate(p=0.001). Multivariable models revealed that BMI was not a predictor of CD in suspected CAD patients(hazard ratio[HR] 0.99; 95%confidence interval[ CI] 0.95 to 1.02) but was an independent inverse predictor of CD in known CAD pa tients(HR 0.95; 95%CI 0.92 to 0.98), especially in women, adenosine stress, low EF, or abnormal perfusion. CONCLUSIONS: Normal MPS was associated with low risk of CD in patients of all weight categories. In patients with known CAD undergoing MPS, obese and overweight patients were at lower risk of CD over three years than normal weight patients.展开更多
Objective: This study was aimed at verifying whether combined information on l eft ventricular perfusion and function by electrocardiogram-gated single-photo n emission computed tomography(SPECT) retains its known pro...Objective: This study was aimed at verifying whether combined information on l eft ventricular perfusion and function by electrocardiogram-gated single-photo n emission computed tomography(SPECT) retains its known prognostic value in pati ents with systemic hypertension. Methods: A total of 415 hypertensive patients u nderwent rest and stress(exercise in 278 and dipyridamole in 137) gated 99mTc-s estamibi SPECT and prospective follow-up for the composite endpoint of death an d acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome was evaluat ed by Cox regression analysis. Model validation was performed using bootstrap me thods adjusted by the degree of optimism in estimates. Survival analysis was per formed using the product-limit Kaplan-Meier method. Results: During a median f ollow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurr ed. After adjusting for the most significant covariates, age[hazard ratio(HR) 1. 62, 95%confidence interval(CI) 1.02-2.57], diabetes(HR 7.51, 95%CI 1.61-35.2 ), summed stress score(HR 2.06, 95%CI 1.07-4), and peak end-systolic volume(H R 3.62, 95%CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end -systolic volume. Conversely, in the case of moderate to severe perfusion abnor malities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was sign ificantly higher among patients who died of a cardiac cause compared with those with different outcomes. Conclusion: A combined assessment of left ventricular p erfusion and function by gated SPECT significantly improves risk strati fication in hypertensive patients.展开更多
文摘OBJECTIVES: The purpose of this study was to assess the relationship between b ody mass index(BMI) and the prognostic value of myocardial perfusion single-pho ton emission computed tomography(MPS). BACKGROUND: The prognostic value of MPS i n the obese has not been evaluated. METHODS: We studied 4,720 patients with and 10,019 patients without known coronary artery disease(CAD) who underwent rest Tl -201/stress Tc-99m sestamibi MPS, including 5,233 gated MPS studies and follow ed up(mean 2.7 to 3.2 years). Patients were categorized as normal weight(BMI 18. 5 to 24.9 kg/m2), overweight(BMI 25.0 to 29.9 kg/m2), or obese(BMI<30.0 kg/m2). RESULTS: Unadjusted annual rates of cardiac death(CD) rose versus stress MPS abn ormalities in all weight groups(p< 0.001). Obese or overweight patients with or without known CAD who had normal MPS were at low CD risk(< 1%/year), similar to normal weight patients. In CAD, obese and overweight patients with abnormal MPS had lower rates of CD compared with normal weight patients(p< 0.01). In patient s with low ejection fraction(EF) by gated MPS, those with normal weight had high est CD rate(p=0.001). Multivariable models revealed that BMI was not a predictor of CD in suspected CAD patients(hazard ratio[HR] 0.99; 95%confidence interval[ CI] 0.95 to 1.02) but was an independent inverse predictor of CD in known CAD pa tients(HR 0.95; 95%CI 0.92 to 0.98), especially in women, adenosine stress, low EF, or abnormal perfusion. CONCLUSIONS: Normal MPS was associated with low risk of CD in patients of all weight categories. In patients with known CAD undergoing MPS, obese and overweight patients were at lower risk of CD over three years than normal weight patients.
文摘Objective: This study was aimed at verifying whether combined information on l eft ventricular perfusion and function by electrocardiogram-gated single-photo n emission computed tomography(SPECT) retains its known prognostic value in pati ents with systemic hypertension. Methods: A total of 415 hypertensive patients u nderwent rest and stress(exercise in 278 and dipyridamole in 137) gated 99mTc-s estamibi SPECT and prospective follow-up for the composite endpoint of death an d acute coronary syndrome. Patients undergoing revascularization were censored. The individual effect of clinical and stress imaging data on outcome was evaluat ed by Cox regression analysis. Model validation was performed using bootstrap me thods adjusted by the degree of optimism in estimates. Survival analysis was per formed using the product-limit Kaplan-Meier method. Results: During a median f ollow-up of 24 months, 12 cardiac deaths and 32 acute coronary syndromes occurr ed. After adjusting for the most significant covariates, age[hazard ratio(HR) 1. 62, 95%confidence interval(CI) 1.02-2.57], diabetes(HR 7.51, 95%CI 1.61-35.2 ), summed stress score(HR 2.06, 95%CI 1.07-4), and peak end-systolic volume(H R 3.62, 95%CI 1.35-9.69) were multivariable predictors of outcome. The normal perfusion pattern was associated with a low event rate independently of peak end -systolic volume. Conversely, in the case of moderate to severe perfusion abnor malities, a peak end-systolic volume greater than 74 ml was able to identify an increased risk of adverse outcome. Moreover, peak end-systolic volume was sign ificantly higher among patients who died of a cardiac cause compared with those with different outcomes. Conclusion: A combined assessment of left ventricular p erfusion and function by gated SPECT significantly improves risk strati fication in hypertensive patients.
