Author + information
- Received July 14, 2009
- Revision received September 16, 2009
- Accepted September 22, 2009
- Published online December 1, 2009.
- Tomoaki Nakata, MD, PhD⁎†⁎ (, )
- Akiyoshi Hashimoto, MD, PhD⁎,
- Takeru Wakabayashi, MD, PhD⁎,
- Hideo Kusuoka, MD, PhD‡ and
- Tsunehiko Nishimura, MD, PhD§
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
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.
- chronic renal dysfunction
- coronary artery disease
- multicenter study
- stress myocardial perfusion imaging
- heart failure
This multicenter study was supported by grants from the Japan Cardiovascular Research Foundation, Suita, Osaka, Japan.
- Received July 14, 2009.
- Revision received September 16, 2009.
- Accepted September 22, 2009.
- American College of Cardiology Foundation