Risk Stratification Using Line Source Attenuation Correction with Rest/stress Tc-99m Sestamibi SPECT Myocardial Perfusion Imaging

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2013 Nov 22

PMID 24259152

Citations 5

Authors

Afrooz Ardestani

Alan W Ahlberg

Deborah M Katten

Krista Santilli

Donna M Polk

Timothy M Bateman

Gary V Heller

Affiliations

Soon will be listed here.

Abstract

Background: Although line source attenuation correction (AC) in SPECT MPI studies improves diagnostic accuracy, its prognostic value is less understood.

Methods: Consecutive patients (n = 6,513) who underwent rest/stress AC ECG-gated SPECT MPI were followed for cardiac death or non-fatal myocardial infarction (MI). A 17-segment model and AC summed stress score (SSS) were used to classify images.

Results: Of the 6,513 patients, cardiac death or non-fatal MI occurred in 267 (4.1%), over 2.0 ± 1.4 years. The AC-SSS in patients with a cardiac event (5.6 ± 7.8) was significantly higher than in those without (1.9 ± 4.6, P < .001). The annualized cardiac event rate in patients with an AC-SSS 1-3 (3.6%) was significantly higher than in those with an AC-SSS = 0 (1.1%, P < .001) but similar to that in those with an AC-SSS 4-8 (2.9%, P = .4). Accordingly, patients were classified to AC-SSS = 0, 1-8, and >8 with annualized cardiac event rates of 1.1%, 3.2%, and 8.5%, respectively (P < .0001). In multivariate analysis, an AC-SSS 1-8 and >8 emerged as independent predictors of cardiac events (P < .02 and P < .0001, respectively).

Conclusion: Rest/stress ECG-gated SPECT MPI with line source AC provides highly effective and incremental risk stratification for future cardiac events.

Citing Articles

Long-term prognostic value of computed tomography-based attenuation correction on thallium-201 myocardial perfusion imaging: A cohort study.

Huang J, Yen R, Huang C, Liu C, Cheng M, Chien K PLoS One. 2021; 16(10):e0258983.

PMID: 34699538 PMC: 8547642. DOI: 10.1371/journal.pone.0258983.

5-Year Prognostic Value of Quantitative Versus Visual MPI in Subtle Perfusion Defects: Results From REFINE SPECT.

Otaki Y, Betancur J, Sharir T, Hu L, Gransar H, Liang J JACC Cardiovasc Imaging. 2019; 13(3):774-785.

PMID: 31202740 PMC: 6899217. DOI: 10.1016/j.jcmg.2019.02.028.

Fully automated analysis of attenuation-corrected SPECT for the long-term prediction of acute myocardial infarction.

Motwani M, Leslie W, Goertzen A, Otaki Y, Germano G, Berman D J Nucl Cardiol. 2017; 25(4):1353-1360.

PMID: 28290099 PMC: 5597460. DOI: 10.1007/s12350-017-0840-0.

Attenuation correction in stress-only myocardial perfusion imaging.

Pazhenkottil A, Kaufmann P, Gaemperli O J Nucl Cardiol. 2016; 24(2):402-404.

PMID: 26829954 DOI: 10.1007/s12350-016-0406-6.

Value of attenuation correction in stress-only myocardial perfusion imaging using CZT-SPECT.

van Dijk J, Mouden M, Ottervanger J, van Dalen J, Knollema S, Slump C J Nucl Cardiol. 2016; 24(2):395-401.

PMID: 26780528 PMC: 5413515. DOI: 10.1007/s12350-015-0374-2.

References

Links J, DePuey E, Taillefer R, Becker L . Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT. J Nucl Cardiol. 2002; 9(2):183-7. DOI: 10.1067/mnc.2002.120163. View

Tan P, Bailey D, Meikle S, Eberl S, Fulton R, Hutton B . A scanning line source for simultaneous emission and transmission measurements in SPECT. J Nucl Med. 1993; 34(10):1752-60. View

Taneja S, Mohan H, Blake G, Livieratos L, Clarke S . Synergistic impact of attenuation correction and gating in routine myocardial SPECT reporting: 2 year follow-up study. Nucl Med Commun. 2008; 29(4):390-7. DOI: 10.1097/MNM.0b013e3282f4d374. View

Hachamovitch R, Berman D, Kiat H, Cohen I, Cabico J, Friedman J . Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation. 1996; 93(5):905-14. DOI: 10.1161/01.cir.93.5.905. View

Chang S, Nabi F, Xu J, Raza U, Mahmarian J . Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. J Am Coll Cardiol. 2009; 55(3):221-30. DOI: 10.1016/j.jacc.2009.09.022. View

Masood Y, Liu Y, DePuey G, Taillefer R, Araujo L, Allen S . Clinical validation of SPECT attenuation correction using x-ray computed tomography-derived attenuation maps: multicenter clinical trial with angiographic correlation. J Nucl Cardiol. 2005; 12(6):676-86. DOI: 10.1016/j.nuclcard.2005.08.006. View

Case J, Hsu B, Bateman T, Cullom S . A Bayesian iterative transmission gradient reconstruction algorithm for cardiac SPECT attenuation correction. J Nucl Cardiol. 2007; 14(3):324-33. DOI: 10.1016/j.nuclcard.2007.02.004. View

Berman D, Hachamovitch R, Kiat H, Cohen I, Cabico J, Wang F . Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995; 26(3):639-47. DOI: 10.1016/0735-1097(95)00218-S. View

Heller G, Bateman T, Johnson L, Cullom S, Case J, Galt J . Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol. 2004; 11(3):273-81. DOI: 10.1016/j.nuclcard.2004.03.005. View

10.

Mathur S, Heller G, Bateman T, Ruffin R, Yekta A, Katten D . Clinical value of stress-only Tc-99m SPECT imaging: importance of attenuation correction. J Nucl Cardiol. 2012; 20(1):27-37. DOI: 10.1007/s12350-012-9633-7. View

11.

Duvall W, Wijetunga M, Klein T, Razzouk L, Godbold J, Croft L . The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study. J Nucl Cardiol. 2010; 17(3):370-7. DOI: 10.1007/s12350-010-9210-x. View

12.

Henzlova M, Cerqueira M, Mahmarian J, Yao S . Stress protocols and tracers. J Nucl Cardiol. 2006; 13(6):e80-90. DOI: 10.1016/j.nuclcard.2006.08.011. View

13.

Nallamouthu N, Araujo L, Russell J, Heo J, Iskandrian A . Prognostic value of simultaneous perfusion and function assessment using technetium-99m sestamibi. Am J Cardiol. 1996; 78(5):562-4. DOI: 10.1016/s0002-9149(96)00366-9. View

14.

Hachamovitch R, Berman D, Kiat H, Cohen I, Lewin H, Amanullah A . Incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography and impact on subsequent management in patients with or suspected of having myocardial ischemia. Am J Cardiol. 1997; 80(4):426-33. DOI: 10.1016/s0002-9149(97)00390-1. View

15.

Heller G, Herman S, Travin M, Baron J, McClellan J . Independent prognostic value of intravenous dipyridamole with technetium-99m sestamibi tomographic imaging in predicting cardiac events and cardiac-related hospital admissions. J Am Coll Cardiol. 1995; 26(5):1202-8. DOI: 10.1016/0735-1097(95)00329-0. View

16.

Germano G, Slomka P, Berman D . Attenuation correction in cardiac SPECT: the boy who cried wolf?. J Nucl Cardiol. 2007; 14(1):25-35. DOI: 10.1016/j.nuclcard.2006.12.317. View

17.

Zanco P, Zampiero A, Favero A, Borsato N, Chierichetti F, Rubello D . Myocardial technetium-99m sestamibi single-photon emission tomography as a prognostic tool in coronary artery disease: multivariate analysis in a long-term prospective study. Eur J Nucl Med. 1995; 22(9):1023-8. DOI: 10.1007/BF00808414. View

18.

Thompson R, Heller G, Johnson L, Case J, Cullom S, Garcia E . Value of attenuation correction on ECG-gated SPECT myocardial perfusion imaging related to body mass index. J Nucl Cardiol. 2005; 12(2):195-202. DOI: 10.1016/j.nuclcard.2004.12.298. View

19.

Ficaro E, Fessler J, Shreve P, Kritzman J, ROSE P, Corbett J . Simultaneous transmission/emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation. 1996; 93(3):463-73. DOI: 10.1161/01.cir.93.3.463. View

20.

Iskandrian A, Chae S, Heo J, Stanberry C, Wasserleben V, Cave V . Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol. 1993; 22(3):665-70. DOI: 10.1016/0735-1097(93)90174-y. View