Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function.

BACKGROUND: The objective of this study was to investigate the impact of clinical, electrocardiographic and stress testing variables in predicting hard cardiac events (HE) and coronary revascularization (CR) in patients with normal stress-rest gated SPECT. MATERIALS AND METHODS: Included in the study were 2,004 patients (63.5 ± 12.5 years, 41.6% men) with normal myocardial perfusion and left ventricular ejection fraction (LVEF) >50% on gated SPECT who were followed for HE (cardiovascular death or acute myocardial infarction) and CR. RESULTS: During a follow-up of 4.3 ± 2.4 years, 33 patients (1.6 %; 0.4%/year) had HE and 50 patients (2.5%; 0.6%/year) underwent CR. In a univariate analysis, age ≥65 years, insulin-dependent diabetes mellitus (IDDM), left bundle branch block (LBBB), and pharmacological stress were associated with HE. Independent predictors of HE were age ≥65 years (p < 0.001; HR 6.9), IDDM (p = 0.014; HR 3.4), and LBBB (p = 0.002; HR 4.6). In the univariate analysis, male gender, LVEF, known coronary artery disease (CAD), LBBB, and a positive stress test were associated with CR. Independent predictors of CR were known CAD (p = 0.016; HR 2.1), and a positive stress test (p = 0.006; HR 2.3). CONCLUSION: Age ≥65 years, IDDM, and LBBB are HE-independent predictors in patients with normal myocardial perfusion and normal LVEF on gated SPECT. The presence of known CAD or a positive stress test significantly increases the probability of CR during follow-up.

Aortic Arch Mycotic Aneurysm Due to Scedosporium Apiospermum Reconstructed With Homografts.

A 39-year-old female, active parenteral drug user was diagnosed of spondylodiscitis. A computed tomography (CT) scan showed an extensive aortic arch aneurysm. A positron emission tomography (PET)-CT scan, showing significant aortic wall uptake of the tracer through the whole aortic arch and the D8-D9 intervertebral disc, allowed us to suspect an aortitis despite negative blood cultures. The aneurysm was resected and reconstructed with 2 aortic homografts. Cultures of specimens from the aortic wall were positive to the fungi Scedosporium apiospermum. A new PET-CT scan 4 months after surgery showed absence of tracer uptake both at the homografts site and intervertebral disc.

Usefulness of exercise test and myocardial perfusion-gated single photon emission computed tomography to improve the prediction of major events.

BACKGROUND: The incremental prognostic value of myocardial perfusion-gated single photon emission computed tomography (MPGS) compared with exercise test has not yet been properly evaluated. METHODS AND RESULTS: Five thousand six hundred seventy-two consecutive patients with known or suspected coronary disease undergoing exercise MPGS between 1997 and 2007 were included. Three-year predictive models for total death and death from cardiovascular causes or acute myocardial infarction (ie, major cardiovascular events [MCE]) were built using Cox-regression modeling, including only the clinical information. Then the exercise and MPGS information was sequentially added. The added discriminative ability of exercise test information and MPGS was assessed by net reclassification improvement and integrated discrimination improvement. The increase in predictive ability of exercise information for death and MCE was high as assessed by net reclassification improvement (0.199 and 0.263) and integrated discrimination improvement (0.042 and 0.021). The only variable of MPGS associated with total death was ejection fraction (hazard ratio, 0.84; 95% confidence interval, 0.79-0.89; P<0.001). Global stress ischemic score emerged as an additional variable associated with MCE (hazard ratio, 1.07; 95% confidence interval, 1.02-1.12; P=0.007). Adding MPGS information barely improved the prognostic value for total death (net reclassification improvement, 0.017; integrated discrimination improvement, 0.013), but it increased for MCE (net reclassification improvement, 0.122; integrated discrimination improvement, 0.033). CONCLUSIONS: Adding MPGS information to exercise information does not improve prediction of total death, although it allows a more accurate prediction of MCE.