Abstract
Myocardial perfusion single photon emission computed tomography (SPECT) is a useful imaging method for prediction of future cardiac events in patients with known or suspected coronary artery disease (CAD) because ischemic indices obtained from myocardial perfusion SPECT provides risk stratification of cardiac events. The cardiac event risk stratification is clinically important for the design of a therapeutic strategy in especially high risk patients with chronic kidney disease or diabetes mellitus as well as patients with CAD. In Japan, the value of myocardial perfusion SPECT for cardiac event risk stratification has also been widely recognized since the initiation of J-ACCESS (the multicenter trial Japanese assessment of cardiac events and survival study). To date, cardiac event risk stratification with myocardial perfusion SPECT has generally been based on conventional semi-quantitative analysis including visual segmental scoring, which requires expert interpretation. However introduction of automated quantification with a total perfusion deficit allows cardiac event risk stratification based on automated quantification without expert interpreters. In addition, recently some equations have been prepared to estimate a cardiac event risk with the scores of multiple predictors. Those equations enable us to predict the risk of cardiac events before treatment. Myocardial perfusion SPECT is a useful modality to stratify the risk of cardiac events and to improve a prognosis in patients with known or suspected CAD.
Highlights
Prediction of cardiac event risk is important for determination of an optimal treatment strategy in patients with coronary artery disease (CAD)
In Japan, the multicenter J-ACCESS III [13] mentioned above was conducted in chronic kidney disease (CKD) patients without a history of CAD; the results demonstrated that three variables, i.e. stress scores (SSS), estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF), are significant predictors of cardiac events in such population
We investigated the ability of the total perfusion deficit (TPD) derived from the Japanese normal database (NDB) to predict future cardiac events in Japanese CAD patients and demonstrated that the predictive power of the automated quantification with the TPD is similar to that of the visual semi-quantification on the basis of the results of receiver operating characteristic analysis (Figure 2) and global chi-square comparison and that the risk of cardiac events can be stratified according to the TPD values (Figure 3) [32]
Summary
Special Issue: The Advancement of Nuclear Cardiology Imaging in the Risk Assessment and Diagnosis. Myocardial perfusion single photon emission computed tomography (SPECT) is a useful imaging method for prediction of future cardiac events in patients with known or suspected coronary artery disease (CAD) because ischemic indices obtained from myocardial perfusion SPECT provides risk stratification of cardiac events. Recently some equations have been prepared to estimate a cardiac event risk with the scores of multiple predictors. Those equations enable us to predict the risk of cardiac events before treatment. Myocardial perfusion SPECT is a useful modality to stratify the risk of cardiac events and to improve a prognosis in patients with known or suspected CAD.
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