Description:
The utility of any imaging procedure depends on its interpretative reproducibility, which is one of the most important factors for using a test. We evaluated whether wall-thickening analysis by gated SPECT is useful in predicting functional recovery after revascularization in patients with coronary artery disease (Eur J Nucl Med Mol Imaging 2005). In such patients wall-thickening analysis by gated SPECT provided additional information compared with perfusion data for the prediction of segmental functional recovery. However, on a patient basis, wall thickening assessment was of more limited value than perfusion status. In another study we directly compared the prognostic value of predischarge dobutamine stress echocardiography (DSE) and dobutamine myocardial SPECT perfusion imaging in patients with prior myocardial infarction (J Nucl Med 2005). The results indicated that, after uncomplicated myocardial infarction, ischemia at SPECT is associated with an increased risk of cardiac events at long-term follow-up. However, ischemia at DSE was unable to stratify patients after myocardial infarction. Furthermore, we assessed the relationships among myocardial viability, changes in left ventricular (LV) ejection fraction after coronary revascularization and long-term event-free survival in patients with previous myocardial infarction and LV dysfunction (Eur J Nucl Med Mol Imaging 2005). In such patients coronary revascularization procedures improved outcome at long-term follow-up independently of LV ejection fraction improvement. In patients who had myocardial infarction the lack of residual myocardial ischemia on SPECT identified those at low risk of events, and a negative finding on stress SPECT was superior to a negative finding on DSE (Am J Cardiol 2005). Our group also compared the interpretative reproducibility of DSE and stress SPECT in patients undergoing pre-discharge simultaneous DSE and SPECT early after a first acute myocardial infarction (Am J Cardiol 2007). The results indicated that in such patients stress SPECT imaging has a better intraobserver and interobserver interpretative reproducibility as compared to DSE. Furthermore, the assessment of myocardial viability is important for the management of patients with chronic ischemic left ventricular dysfunction. In patients with previous myocardial infarction, we demonstrated that the presence of viable myocardium at nitrate SPECT imaging predicts major cardiac events at long-term follow-up, also in the absence of inducible ischemia, and the risk increases with the extent of viability (J Card Fail 2007). In another investigation, we showed that in such patients the prognostic value of SPECT imaging after nitrate is comparable to that of metabolic imaging by positron emission tomography (Eur J Nucl Med Mol Imaging 2007). Finally, we demonstrated that in patients with ischemic left ventricular dysfunction viability assessment by nitrate SPECT imaging provides incremental prognostic information over those obtained from clinical, functional, angiographic variables and baseline SPECT data (J Nucl Cardiol 2009)