Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role?
Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role?
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DOI：
10.1016/j.jacc.2009.04.042
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发表时间：
2009-08-04
影响因子：
24
通讯作者：
Beller, George A.
中科院分区：
文献类型：
--
作者：
Bourque, Jamieson M.;Holland, Benjamin H.;Watson, Denny D.;Beller, George A.
我们试图前瞻性地确定运动SPECT成像相对于心肌灌注成像（MPI）的连续患者中达到的工作负荷的显著缺血（≥10%的左心室（LV））的患病率。高运动能力是良好预后的有力预测因素，MPI在实现高工作负荷的患者中的作用值得怀疑。对1,056例接受定量运动门控99 mTc-SPECT MPI的连续患者进行了前瞻性分析，其中974例达到了其最大年龄预测心率（MAPHR）的≥85%。根据达到的运动负荷（<7、7-9或≥10 METS）对这些患者进行进一步分类，并比较运动试验和影像学结局，特别是≥10% LV缺血的患病率。还评估了达到≥10 METS但<85% MAPHR的个体。在这974例受试者中，473例（48.6%）达到≥10个METS。该亚组的严重缺血发生率非常低（2/473，0.4%）。那些达到<7 METS的人的患病率高出18倍（7.1%，p<0.001）。在430例达到≥10 METS且无运动ST段压低的患者中，无≥10% LV缺血。相比之下，≥10%的LV缺血的患病率在达到<10 METS的ST段压低患者中最高（14/70; 19.4%）。在这个具有中度至高度CAD临床风险的患者转诊队列中，达到≥10个METS且无缺血性ST段压低与0%的严重缺血患病率相关。在这些患者中消除MPI，占该实验室所有接受运动SPECT的患者的31%（430/1396），可以节省大量成本。
We sought to identify prospectively the prevalence of significant ischemia (≥10% of the left ventricle (LV)) on exercise SPECT imaging relative to workload achieved in consecutive patients referred for myocardial perfusion imaging (MPI). High exercise capacity is a strong predictor of a good prognosis, and the role of MPI in patients achieving high workloads is questionable. Prospective analysis was performed on 1,056 consecutive patients who underwent quantitative exercise gated 99mTc-SPECT MPI, of whom 974 attained ≥85% of their maximum age-predicted heart rate (MAPHR). These patients were further divided based on attained exercise workload (<7, 7-9, or ≥10 METS) and were compared for exercise test and imaging outcomes, particularly the prevalence of ≥10% LV ischemia. Individuals reaching ≥10 METS but <85% MAPHR were also assessed. Of these 974 subjects, 473 (48.6%) achieved ≥10 METS. This subgroup had a very low prevalence of significant ischemia (2 of 473, 0.4%). Those attaining <7 METS had an 18-fold higher prevalence (7.1%, p<0.001). Of the 430 patients reaching ≥10 METS without exercise ST-depression, none had ≥10% LV ischemia. In contrast, the prevalence of ≥10% LV ischemia was highest in the patients achieving <10 METS with ST-depression (14 of 70; 19.4%). In this referral cohort of patients with an intermediate to high clinical risk of CAD, achieving ≥10 METS with no ischemic ST-depression was associated with a 0% prevalence of significant ischemia. Elimination of MPI in such patients, who represented 31% (430/1396) of all undergoing exercise SPECT in this laboratory, could provide substantial cost-savings.
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影响因子：
158.5
作者：
MARK, DB;SHAW, L;PRYOR, DB
通讯作者：
PRYOR, DB
DOI：
10.1016/s0735-1097(84)80254-5
发表时间：
1984-01-01
影响因子：
24
作者：
WEINER, DA;RYAN, TJ;TRISTANI, F
通讯作者：
TRISTANI, F
DOI：
10.1016/s0735-1097(02)02164-2
发表时间：
2002-10-16
影响因子：
24
作者：
Gibbons, RJ;Balady, GJ;Smith, SC
通讯作者：
Smith, SC
DOI：
10.1016/s0735-1097(03)00832-5
发表时间：
2003-09-03
影响因子：
24
作者：
Elhendy, A;Mahoney, DW;Pellikka, PA
通讯作者：
Pellikka, PA
影响因子：
37.8
作者：
Gulati, M;Pandey, DK;Black, HR
通讯作者：
Black, HR