ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2012
The prognosis of a normal Tl-201 stress-only SPECT MPI study.
Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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12 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Update of the Brazilian Guideline on Nuclear Cardiology - 2020.Arquivos brasileiros de cardiologia · 2020Guideline
- The incremental value of coronary artery calcium score in predicting long-term prognosis and defining the warranty period of normal adenosine stress-only myocardial perfusion imaging using CZT SPECT.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Article
- Nuclear cardiology for a cardiothoracic surgeon.Indian journal of thoracic and cardiovascular surgery · 2022Review
- Prognostically safe stress-only single-photon emission computed tomography myocardial perfusion imaging guided by machine learning: report from REFINE SPECT.European heart journal. Cardiovascular Imaging · 2021Article
- Performance analysis of a high-sensitivity multi-pinhole cardiac SPECT system with hemi-ellipsoid detectors.Medical physics · 2019Article
- Tl-201 dosing for CZT SPECT: More new information.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2018Article
- Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease-state-of-the-evidence and clinical recommendations.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2017Article
- Outcome of patients with high-risk Duke treadmill score and normal myocardial perfusion imaging on spect.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2016Article
- Feasibility of stress only rubidium-82 PET myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2013Article
- Prognosis of patients without perfusion defects with and without rest study in myocardial perfusion scintigraphy.EJNMMI research · 2013Article
- Stress first myocardial perfusion imaging: is it time to put to rest the "rest first" strategy for most patients?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2012Article
- Higher event rate in patients with high-risk Duke Treadmill Score despite normal exercise-gated myocardial perfusion imaging.World journal of nuclear medicineArticle
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStress-only Tc-99m SPECT myocardial perfusion imaging (MPI) decreases test time and patient radiation exposure with a proven benign prognosis of a normal study. The imaging sequence of Tl-201 MPI always starts with the stress portion; therefore, no pre-test decisions are needed regarding the imaging sequence. The recent intermittent Tc-99m shortage afforded the unique opportunity to study an unselected group of patients undergoing Tl-201 imaging.
methodsWe retrospectively reviewed all the patients who had SPECT MPI with Tc-99m or Tl-201 over a 1-year period. When Tc-99m was not available, patients received Tl-201. All stress Tl-201 images were routinely processed, and if normal, rest imaging was not done. When Tc-99m was used, patients with lower pre-test probability were selected for a stress-first protocol. We compared the all-cause mortality of patients with normal Tl-201 studies to those with normal stress-only and rest-stress Tc-99m studies using the Social Security Death Index. Unadjusted and risk-adjusted survival analysis was performed. Specific causes of death (cardiac or non-cardiac) were determined by medical record review and contact with treating physicians.
resultsA total of 3,658 patients underwent stress MPI during this time period. Of the 1,215 patients who had Tl-201 MPI, 716 (67%) had a normal stress-only study. Out of 2,443 patients who underwent Tc-99m MPI, 70% had normal perfusion with 1,098 normal stress-only studies and 493 normal rest-stress studies. The average follow-up was 23.3 ± 5.3 months. Unadjusted all-cause mortality at the end of follow-up was 7.1% in the Tl-201 stress-only group, 6.3% for Tc-99m stress-only patients, and 4.3% in the Tc-99m rest-stress cohort. After controlling for confounding variables, survival was similar in the three groups (HR 1.07, 95% CI 0.62-1.82, P = .82 for normal Tl-201 stress-only compared to normal Tc-99m rest-stress). The risk-adjusted 1-year survival was between 98.5 and 98.8% in the three groups.
conclusionsNormal stress-only Tl-201 SPECT MPI study has a similarly benign prognosis when compared to Tc-99m rest-stress and Tc-99m stress-only normal SPECT MPI studies. The stress-first design allowed for early triage of over 60% of patients and marked improvement in laboratory efficiency due to shortened test time.
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