Prediction of New-Onset Refractory Congestive Heart Failure Using Gated Myocardial Perfusion SPECT Imaging in Patients With Known or Suspected Coronary Artery DiseaseSubanalysis 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
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Figure 1 Kaplan-Meier Event-Free Curves of the 3 Subgroups Based on the SSS
The severe summed stress score (SSS) subgroup (SSS  14) and the moderate SSS subgroup (SSS 9–13) had significantly lower event-free rates than did the normal to low SSS subgroup (SSS 0–8). *#Versus normal-low, p < 0.0001.
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Figure 2 Kaplan-Meier Event-Free Curves Based on End-Systolic Volume Index
Kaplan-Meier event-free curves of the 3 subgroups based on end-systolic volume index (ESVI) (ml/m2). The higher ESVI subgroup had a significantly lower event-free rate than did the moderate or lower ESVI subgroup. *Versus normal-low, p < 0.0001; #versus moderate, p = 0.0001.
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Figure 3 Event Rates of Refractory HF in Each SSS Category
Event rates of new-onset refractory heart failure (HF) in each SSS category tend to increase with the end-systolic volume index (ESVI); based on the ESVI tertile, patients were classified as either lower ( 13 ml/m2, yellow columns), moderate (14 to 22 ml/m2, pink columns), or greater (23 ml/m2, green columns). The minimal risk (0.3%/3 years) at a normal to low SSS and lower ESVI increases to the approximately 17 times greater risk (5.0% to 5.2%/3 years) at a moderate to high SSS with a moderate to higher ESVI.
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Figure 4 Global Chi-Square Values for Predicting New-Onset Refractory HF
Global chi-square values for predicting new-onset refractory heart failure (HF) significantly and incrementally increase when chronic renal dysfunction (CRD), end-systolic volume index (ESVI), and summed stress score (SSS), all of which were determined by multivariable Cox analysis, are combined.
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