The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing
The frequency of inducible myocardial ischemia has declined in contemporary stress test cohorts, suggesting a need to re-evaluate its optimal use. To-date, however, a comprehensive analysis of the most potent predictors of myocardial ischemia among cardiac stress test patients has not been conducted...
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| Veröffentlicht in: | Journal of nuclear cardiology 2022-12, Vol.29 (6), p.2839-2849 |
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| container_title | Journal of nuclear cardiology |
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| creator | Rozanski, Alan Miller, Robert J.H. Han, Donghee Gransar, Heidi Slomka, Piotr Dey, Damini Hayes, Sean B. Friedman, John Thomson, Louise B. Berman, Daniel S. |
| description | The frequency of inducible myocardial ischemia has declined in contemporary stress test cohorts, suggesting a need to re-evaluate its optimal use. To-date, however, a comprehensive analysis of the most potent predictors of myocardial ischemia among cardiac stress test patients has not been conducted.
We assessed 27,615 patients referred for stress-rest SPECT myocardial perfusion imaging between January 1, 2004 and December 31, 2017. Chi-square analysis was used to ascertain the most potent predictors of ischemia.
Among our cohort, CAD status (presence/absence of known CAD), rest left ventricular ejection fraction (LVEF), and typical angina were the most potent predictors of ischemia. The frequency of ischemia was only 6.6% among patients with an LVEF > 55% but 38.1% for patients with LVEF < 45% (P < 0.001). The frequency of myocardial ischemia was fourfold higher among patients with known CAD vs no known CAD (28.0% vs 6.5%, P < 0.001) and approximately threefold higher among patients with typical angina vs patients with atypical symptoms (P < 0.001).
The frequency of myocardial ischemia varies markedly according to the common clinical parameters and is particularly high among patients with known CAD, low LVEF, and typical angina. These observations may be used to develop more cost-effective strategies for referring patients for cardiac stress testing. |
| doi_str_mv | 10.1007/s12350-021-02797-2 |
| format | Article |
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We assessed 27,615 patients referred for stress-rest SPECT myocardial perfusion imaging between January 1, 2004 and December 31, 2017. Chi-square analysis was used to ascertain the most potent predictors of ischemia.
Among our cohort, CAD status (presence/absence of known CAD), rest left ventricular ejection fraction (LVEF), and typical angina were the most potent predictors of ischemia. The frequency of ischemia was only 6.6% among patients with an LVEF > 55% but 38.1% for patients with LVEF < 45% (P < 0.001). The frequency of myocardial ischemia was fourfold higher among patients with known CAD vs no known CAD (28.0% vs 6.5%, P < 0.001) and approximately threefold higher among patients with typical angina vs patients with atypical symptoms (P < 0.001).
The frequency of myocardial ischemia varies markedly according to the common clinical parameters and is particularly high among patients with known CAD, low LVEF, and typical angina. These observations may be used to develop more cost-effective strategies for referring patients for cardiac stress testing.</description><identifier>ISSN: 1071-3581</identifier><identifier>EISSN: 1532-6551</identifier><identifier>DOI: 10.1007/s12350-021-02797-2</identifier><identifier>PMID: 34608604</identifier><language>eng</language><publisher>Cham: Elsevier Inc</publisher><subject>Angina pectoris ; Angina Pectoris - diagnostic imaging ; Angina Pectoris - epidemiology ; cardiac stress testing ; Cardiac stress tests ; Cardiology ; coronary artery disease ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Exercise Test ; Humans ; Imaging ; Ischemia ; Medicine ; Medicine & Public Health ; Myocardial ischemia ; Myocardial Ischemia - diagnostic imaging ; Myocardial Ischemia - epidemiology ; Myocardial Perfusion Imaging - methods ; Nuclear Medicine ; Original Article ; Prevalence ; Radioisotopes ; Radiology ; SPECT myocardial perfusion imaging ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon - methods ; Ventricular Function, Left</subject><ispartof>Journal of nuclear cardiology, 2022-12, Vol.29 (6), p.2839-2849</ispartof><rights>2022 American Society of Nuclear Cardiology. Published by ELSEVIER INC. All rights reserved.</rights><rights>American Society of Nuclear Cardiology 2021</rights><rights>2021. American Society of Nuclear Cardiology.</rights><rights>American Society of Nuclear Cardiology 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-e03fb7584890b6b19ddc266b803e5df4be589a960ddf6d71dfaaffdf1c4e4cd73</citedby><cites>FETCH-LOGICAL-c428t-e03fb7584890b6b19ddc266b803e5df4be589a960ddf6d71dfaaffdf1c4e4cd73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12350-021-02797-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s12350-021-02797-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34608604$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rozanski, Alan</creatorcontrib><creatorcontrib>Miller, Robert J.H.</creatorcontrib><creatorcontrib>Han, Donghee</creatorcontrib><creatorcontrib>Gransar, Heidi</creatorcontrib><creatorcontrib>Slomka, Piotr</creatorcontrib><creatorcontrib>Dey, Damini</creatorcontrib><creatorcontrib>Hayes, Sean B.</creatorcontrib><creatorcontrib>Friedman, John</creatorcontrib><creatorcontrib>Thomson, Louise B.</creatorcontrib><creatorcontrib>Berman, Daniel S.</creatorcontrib><title>The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing</title><title>Journal of nuclear cardiology</title><addtitle>J. Nucl. Cardiol</addtitle><addtitle>J Nucl Cardiol</addtitle><description>The frequency of inducible myocardial ischemia has declined in contemporary stress test cohorts, suggesting a need to re-evaluate its optimal use. To-date, however, a comprehensive analysis of the most potent predictors of myocardial ischemia among cardiac stress test patients has not been conducted.
We assessed 27,615 patients referred for stress-rest SPECT myocardial perfusion imaging between January 1, 2004 and December 31, 2017. Chi-square analysis was used to ascertain the most potent predictors of ischemia.
Among our cohort, CAD status (presence/absence of known CAD), rest left ventricular ejection fraction (LVEF), and typical angina were the most potent predictors of ischemia. The frequency of ischemia was only 6.6% among patients with an LVEF > 55% but 38.1% for patients with LVEF < 45% (P < 0.001). The frequency of myocardial ischemia was fourfold higher among patients with known CAD vs no known CAD (28.0% vs 6.5%, P < 0.001) and approximately threefold higher among patients with typical angina vs patients with atypical symptoms (P < 0.001).
The frequency of myocardial ischemia varies markedly according to the common clinical parameters and is particularly high among patients with known CAD, low LVEF, and typical angina. These observations may be used to develop more cost-effective strategies for referring patients for cardiac stress testing.</description><subject>Angina pectoris</subject><subject>Angina Pectoris - diagnostic imaging</subject><subject>Angina Pectoris - epidemiology</subject><subject>cardiac stress testing</subject><subject>Cardiac stress tests</subject><subject>Cardiology</subject><subject>coronary artery disease</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Exercise Test</subject><subject>Humans</subject><subject>Imaging</subject><subject>Ischemia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Myocardial ischemia</subject><subject>Myocardial Ischemia - diagnostic imaging</subject><subject>Myocardial Ischemia - epidemiology</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Nuclear Medicine</subject><subject>Original Article</subject><subject>Prevalence</subject><subject>Radioisotopes</subject><subject>Radiology</subject><subject>SPECT myocardial perfusion imaging</subject><subject>Stroke Volume</subject><subject>Tomography, Emission-Computed, Single-Photon - methods</subject><subject>Ventricular Function, Left</subject><issn>1071-3581</issn><issn>1532-6551</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9rHSEUxYfS0KRpv0AXReimm2muOo4jdFNC_0Ggm2Qtjl5fDDP6qjMP8u3jy6QtdJGF6MVzzr36a5p3FD5RAHlRKOMCWmC0Lqlky140Z1Rw1vZC0Jf1DJK2XAz0tHldyh0AKK7Uq-aUdz0MPXRnzeH6Fsk-48FMGC0SE92xdMEuKReSPAnRrTaME5L5PlmTXTATCcXe4hwMMXOKO7I3S8C4FJLRY6524lMm2biQ4mqn4JCUJWMpZMGyhLh705x4MxV8-7SfNzffvl5f_mivfn3_efnlqrUdG5YWgftRiqEbFIz9SJVzlvX9OABH4Xw3ohiUUT0453snqfPGeO88tR121kl-3nzccvc5_V5rbz3X0XGaTMS0Fs2EVFwqJoYq_fCf9C6tOdbpNJN910kAClXFNpXNqZT6XL3PYTb5XlPQRyp6o6IrFf1IRbNqev8UvY4zur-WPxiqgG-CUq_iDvO_3s_Gft5cWH_wEKqr2HCk6EJGu2iXwnP2B_VRrhY</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Rozanski, Alan</creator><creator>Miller, Robert J.H.</creator><creator>Han, Donghee</creator><creator>Gransar, Heidi</creator><creator>Slomka, Piotr</creator><creator>Dey, Damini</creator><creator>Hayes, Sean B.</creator><creator>Friedman, John</creator><creator>Thomson, Louise B.</creator><creator>Berman, Daniel S.</creator><general>Elsevier Inc</general><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20221201</creationdate><title>The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing</title><author>Rozanski, Alan ; Miller, Robert J.H. ; Han, Donghee ; Gransar, Heidi ; Slomka, Piotr ; Dey, Damini ; Hayes, Sean B. ; Friedman, John ; Thomson, Louise B. ; Berman, Daniel S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-e03fb7584890b6b19ddc266b803e5df4be589a960ddf6d71dfaaffdf1c4e4cd73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Angina pectoris</topic><topic>Angina Pectoris - diagnostic imaging</topic><topic>Angina Pectoris - epidemiology</topic><topic>cardiac stress testing</topic><topic>Cardiac stress tests</topic><topic>Cardiology</topic><topic>coronary artery disease</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Exercise Test</topic><topic>Humans</topic><topic>Imaging</topic><topic>Ischemia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Myocardial ischemia</topic><topic>Myocardial Ischemia - diagnostic imaging</topic><topic>Myocardial Ischemia - epidemiology</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Nuclear Medicine</topic><topic>Original Article</topic><topic>Prevalence</topic><topic>Radioisotopes</topic><topic>Radiology</topic><topic>SPECT myocardial perfusion imaging</topic><topic>Stroke Volume</topic><topic>Tomography, Emission-Computed, Single-Photon - methods</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rozanski, Alan</creatorcontrib><creatorcontrib>Miller, Robert J.H.</creatorcontrib><creatorcontrib>Han, Donghee</creatorcontrib><creatorcontrib>Gransar, Heidi</creatorcontrib><creatorcontrib>Slomka, Piotr</creatorcontrib><creatorcontrib>Dey, Damini</creatorcontrib><creatorcontrib>Hayes, Sean B.</creatorcontrib><creatorcontrib>Friedman, John</creatorcontrib><creatorcontrib>Thomson, Louise B.</creatorcontrib><creatorcontrib>Berman, Daniel S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of nuclear cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rozanski, Alan</au><au>Miller, Robert J.H.</au><au>Han, Donghee</au><au>Gransar, Heidi</au><au>Slomka, Piotr</au><au>Dey, Damini</au><au>Hayes, Sean B.</au><au>Friedman, John</au><au>Thomson, Louise B.</au><au>Berman, Daniel S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing</atitle><jtitle>Journal of nuclear cardiology</jtitle><stitle>J. Nucl. Cardiol</stitle><addtitle>J Nucl Cardiol</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>29</volume><issue>6</issue><spage>2839</spage><epage>2849</epage><pages>2839-2849</pages><issn>1071-3581</issn><eissn>1532-6551</eissn><abstract>The frequency of inducible myocardial ischemia has declined in contemporary stress test cohorts, suggesting a need to re-evaluate its optimal use. To-date, however, a comprehensive analysis of the most potent predictors of myocardial ischemia among cardiac stress test patients has not been conducted.
We assessed 27,615 patients referred for stress-rest SPECT myocardial perfusion imaging between January 1, 2004 and December 31, 2017. Chi-square analysis was used to ascertain the most potent predictors of ischemia.
Among our cohort, CAD status (presence/absence of known CAD), rest left ventricular ejection fraction (LVEF), and typical angina were the most potent predictors of ischemia. The frequency of ischemia was only 6.6% among patients with an LVEF > 55% but 38.1% for patients with LVEF < 45% (P < 0.001). The frequency of myocardial ischemia was fourfold higher among patients with known CAD vs no known CAD (28.0% vs 6.5%, P < 0.001) and approximately threefold higher among patients with typical angina vs patients with atypical symptoms (P < 0.001).
The frequency of myocardial ischemia varies markedly according to the common clinical parameters and is particularly high among patients with known CAD, low LVEF, and typical angina. These observations may be used to develop more cost-effective strategies for referring patients for cardiac stress testing.</abstract><cop>Cham</cop><pub>Elsevier Inc</pub><pmid>34608604</pmid><doi>10.1007/s12350-021-02797-2</doi><tpages>11</tpages></addata></record> |
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| subjects | Angina pectoris Angina Pectoris - diagnostic imaging Angina Pectoris - epidemiology cardiac stress testing Cardiac stress tests Cardiology coronary artery disease Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Exercise Test Humans Imaging Ischemia Medicine Medicine & Public Health Myocardial ischemia Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - epidemiology Myocardial Perfusion Imaging - methods Nuclear Medicine Original Article Prevalence Radioisotopes Radiology SPECT myocardial perfusion imaging Stroke Volume Tomography, Emission-Computed, Single-Photon - methods Ventricular Function, Left |
| title | The prevalence and predictors of inducible myocardial ischemia among patients referred for radionuclide stress testing |
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