This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nakata, T. Articles by Nishimura, T. Search for Related Content PubMed Articles by Nakata, T. Articles by Nishimura, T. Related Collections Related Article

Prediction of New-Onset Refractory Congestive Heart Failure Using Gated Myocardial Perfusion SPECT Imaging in Patients With Known or Suspected Coronary Artery Disease

Subanalysis of the J-ACCESS Database

Tomoaki Nakata, MD, PhD^_*,,_*, Akiyoshi Hashimoto, MD, PhD^_*, Takeru Wakabayashi, MD, PhD^_*, Hideo Kusuoka, MD, PhD, Tsunehiko Nishimura, MD, PhD

^_* Sapporo Medical University School of Medicine, Sapporo, Japan
Hokkaido Prefectural Esashi Hospital, Esashi, Japan
Osaka National Hospital, Osaka, Japan
Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

^_* Reprint requests and correspondence: Dr. Tomoaki Nakata, Second Department of Internal Medicine (Cardiology), Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-8543, Japan (Email: tnakata{at}sapmed.ac.jp).

Objectives: The purpose of this study was to evaluate the predictive value of perfusion/function parameters measured by gated myocardial perfusion single-photon emission computed tomography (SPECT) in combination with clinical variables in patients with known or suspected coronary artery disease to predict refractory heart failure (HF).

Background: The increasing number of HF patients requires the establishment of a prophylactic strategy that can identify patients at high risk of HF due to coronary artery disease.

Methods: We analyzed clinical and stress/rest-gated SPECT data from the multicenter, prospective, and observational J-ACCESS (Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT) database of 3,835 known or suspected coronary artery disease patients in which new-onset congestive HF symptoms requiring aggressive medical treatment were observed in 71 patients for 3 years.

Results: The multivariable Cox hazard model revealed that chronic renal dysfunction (hazard ratio (HR): 6.227 [95% confidence interval (CI): 2.920 to 13.279]), the end-systolic volume index (ESVI) (HR: 1.019 [95% CI: 1.011 to 1.029]), and moderate to high stress summed score (SSS) (HR: 3.012 [95% CI: 1.757 to 5.181]) independently (p < 0.0001) predicted HF. In addition to the close (p < 0.0001) correlation of ESVI and SSS with HF incidence, the combined tertiles of SSS and ESVI revealed high-risk patients with a maximally 17.3 times greater risk (5.2%/3 years) compared with the minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI. Chronic renal dysfunction combined with ESVI and SSS categories had the greatest (p < 0.005 to 0.001) incremental prognostic value with a global chi-square value (125.0) over single or other combined risks.

Conclusions: Chronic renal dysfunction, greater stress-induced perfusion abnormality, and higher ESVI provide independent and additive information for predicting the risk of refractory HF in known or suspected coronary patients, indicating the efficacy of perfusion/function parameters measured by stress-gated perfusion SPECT for identifying patients at greater risk of future refractory HF.

Key Words: chronic renal dysfunction • coronary artery disease • multicenter study • prognosis • stress myocardial perfusion imaging • heart failure

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   ESVI = end-systolic volume index   HF = heart failure   HR = hazard ratio   MI = myocardial infarction   SPECT = single-photon emission computed tomography   SSS = summed stress score

Related Article

Gated SPECT Myocardial Perfusion Imaging for the Prediction of Incident Heart Failure: An Old Dog Learns a New Trick

Prem Soman and James E. Udelson
J. Am. Coll. Cardiol. Img. 2009 2: 1401-1403. [Full Text] [PDF]

This article has been cited by other articles:

				P. Soman and J. E. Udelson Gated SPECT Myocardial Perfusion Imaging for the Prediction of Incident Heart Failure: An Old Dog Learns a New Trick J. Am. Coll. Cardiol. Img., December 1, 2009; 2(12): 1401 - 1403. [Full Text] [PDF]