ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2013
A hypothetical protocol for the provisional use of perfusion imaging with exercise stress testing.
Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 19 citations in OpenAlex.
- Rise and fall, and provisional rebirth of exercise stress testing at the dawn of the third millennium.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- The additional prognostic value of myocardial perfusion SPECT in patients with known coronary artery disease with high exercise capacity.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Staged testing as a solution to the challenges of testing lower risk patients.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- A high exercise workload of ≥ 10 METS predicts a low risk of significant ischemia and cardiac events in older adults.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Clinical effectiveness of an outpatient pathway for low-risk chest pain emergency department visits.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Low-dose stress-only myocardial perfusion imaging.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Stress protocol and accuracy of myocardial perfusion imaging: Is it better to start from the end?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2016Article
- Value of Exercise ECG for Risk Stratification in Suspected or Known CAD in the Era of Advanced Imaging Technologies.JACC. Cardiovascular imaging · 2015Review
- Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing.European journal of nuclear medicine and molecular imaging · 2015Article
- Cardiovascular risk stratification in diabetic patients: is all in METS?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2014Article
- A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2014Article
- Provisional use of myocardial perfusion imaging in patients undergoing exercise stress testing: a worthy concept fraught with challenges.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2013Article
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6 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPrevious literature suggests that the results of myocardial perfusion imaging (MPI) add little to the prognosis of patients who exercise >10 metabolic equivalents (METS) during stress testing. With this in mind, we attempted to determine if a provisional injection protocol could be developed in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response. This protocol would save a substantial amount of time, radiation exposure, and cost.
methodsAll patients who underwent a stress SPECT MPI over a 6.5-year period from 2004 to 2010 were included. Patients who would have been considered for a standby injection protocol were: exercise stress, age < 65, no known coronary artery disease (CAD), and an interpretable ECG. Patients were retrospectively divided into two groups based on whether they would have received radioisotope or not. Criteria for not injecting included a maximal predicted heart rate ≥ 85%, ≥10 METS of exercise, no symptoms of chest pain or shortness of breath, and no ECG changes (ST depression or arrhythmia). The two groups were then compared based on MPI results and all-cause mortality derived from the Social Security Death Index.
resultsA total of 24,689 patients underwent SPECT MPI during this period, and 5,352 would have been eligible for a provisional injection protocol. There were 3,791 (70.8%), who would have been injected and 1,561 (29.2%), who would not have been. Perfusion results were abnormal in 5.9% of non-injected group compared to 14.4% in those who would have been injected. After a mean follow-up of 60.6 ± 21.4 months, 1.1% had died in the non-injected cohort compared to 2.2% in the injected group.
conclusionA provisional injection protocol defined as age < 65, normal rest ECG, no history of CAD, and high level exercise with a negative ECG response and no symptoms has a very low 5-year all-cause mortality and low yield of MPI. If adopted it would decrease radiation exposure and save time and health care costs without jeopardizing prognosis.
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