Myocardial perfusion imaging is a strong predictor of death in women.

OBJECTIVES: We sought to assess the prognostic value and risk classification improvement using contemporary single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) to predict all-cause mortality. BACKGROUND: Myocardial perfusion is a strong estimator of prognosis. Evidence published to date has not established the added prognostic value of SPECT-MPI nor defined an approach to detect improve classification of risk in women from a developing nation. METHODS: A total of 2,225 women referred for SPECT-MPI were followed by a mean period of 3.7 ± 1.4 years. SPECT-MPI results were classified as abnormal on the presence of any perfusion defect. Abnormal scans were further classified as with mild/moderate reversible, severe reversible, partial reversible, or fixed perfusion defects. Risk estimates for incident mortality were categorized as <1%/year, 1% to 2%/year, and >2%/year using Cox proportional hazard models. Risk-adjusted models incorporated clinical risk factors, left ventricular ejection fraction (LVEF), and perfusion variables. RESULTS: All-cause death occurred in 139 patients. SPECT-MPI significantly risk stratified the population; patients with abnormal scans had significantly higher death rates compared with patients with normal scans, 13.1% versus 4.0%, respectively (p < 0.001). Cox analysis demonstrated that after adjusting for clinical risk factors and LVEF, SPECT-MPI improved the model discrimination (integrated discrimination index = 0.009; p = 0.02), added significant incremental prognostic information (global chi-square increased from 87.7 to 127.1; p < 0.0001), and improved risk prediction (net reclassification improvement = 0.12; p = 0.005). CONCLUSIONS: SPECT-MPI added significant incremental prognostic information to clinical and left ventricular functional variables while enhancing the ability to classify this Brazilian female population into low- and high-risk categories of all-cause mortality.

Níveis de LDL-C, HDL-C e de apolipoproteínas B e A-I em indivíduos normo e hiperlipidêmcos e suas correlações com os níveis de triglicérides / Levels of LDL-C, HDL-C and apolipoproteins B and A-I normo and hyperlipidemic indiviuals and their correlations with triglyceride levels

Os níveis plasmáticos de LDL-colesterol (LDL-C), HDL-colesterol (HDL-C), apolipoproteínas B (apo B) e A-I (apo A-I) foram estimados em 38 indivíduos hiperlipidêmicos (HL) e 42 normolipidêmicos (NL). Coeficientes de correlação, entre essas variáveis e os níveis de TG, foram calculados, em cada grupo. O teor de LDL-C, apo B e as razões LDL-C/HDL-C e apo B/apo A-I apresentaram-se significativamente maiores (p>0,001) nos HL do que nos NL. Entretanto, utilizando-se análise discriminante, observamos que a discriminação mais acentuada, nos hl, foi obtida pela razão apo B/apo A-I, que classificou 87% dos pacientes no grupo correto. O teor de HDL-C foi significativamente menor no grupo dos HL do que no de NL (p0,05). No grupo de NL, os resultados da correlação entre os níveis de TG com as outras variáveis fora: a) positiva e significativa com os níveis de LDL-C e apo B; b) negativa e significativa com os níveis de HDL-C; c) não significativa com o nível de apo A-I. No grupo de HL, encontramos correlações negativas entre os níveis de TG com os de LDL-C, HDL-C, não havendo correlação significativa com apo B e apo A-I.