Prognostic value of myocardial perfusion-gated SPECT in patients with ischemic cardiomyopathy.

ABSTRACT

BACKGROUND: There are no extensive series in which risk stratification of patients with ischemic cardiomyopathy (IC) is based on their rest and exercise and scintigraphic characteristics. The purpose of our study was to analyze rest and exercise myocardial perfusion-gated SPECT variables for prognosis in patients with ischemic IC. METHODS AND RESULTS: Prospective cohort study. A study was performed in 167 patients with IC who consecutively underwent rest myocardial perfusion-gated SPECT. In addition, stress SPECT was performed on 137 of these patients. During an average follow-up of 2.3 +/- 1.2 years, cardiac mortality (CM) was 17.4%. Independent predictors of CM in rest-gated SPECT were the positive criteria for myocardial viability (P = 0.027; Hazard risk, HR 5.1; 95% CI 1.2-21.4). In the 137 patients who underwent stress-gated SPECT, predictors were scintigraphic criteria for viability plus ischemia (P = 0.026; HR 3.6; 95% CI 1.16-11.2) and exercise duration < or = 5 minutes (P = 0.04; HR 2.7; 95% CI 1.01-7.36). Coronary angiography variables, performed in 111 patients, did not significantly modify the prognostic value of non-invasive testing. CONCLUSION: Myocardial perfusion-gated SPECT improves prognostic stratification of patients with IC.