Relationship of Myocardial Perfusion Imaging Findings to Outcome
Relationship of Myocardial Perfusion Imaging Findings to Outcome
Background: We retrospectively identified heart failure patients with suspected ischemic heart disease who underwent myocardial perfusion imaging (MPI) to examine the relationship of MPI findings to subsequent patient outcomes.
Methods: The study group consisted of 336 patients with heart failure, left ventricular ejection fraction <45%, and suspected ischemic heart disease who underwent MPI during the period of January 1991 to December 31, 1997. Patients were divided in 3 subgroups: group A (n = 137), large fixed perfusion defects; group B (n = 77), large reversible perfusion defects; and group C (n=122), absence of a large reversible or fixed perfusion defect.
Results: Overall, the 5-year mortality rate was high at 49.2% ± 3.1%. Mortality was significantly different (P = .009) among the 3 subgroups. Groups A and B had a similar 5-year mortality rates >50%. Group C had a relatively better, but still substantial 5-year mortality rate of 40%. The overall revascularization rate was low (9.7% in 5 years).
Conclusion: These results indicate a high 5-year mortality rate in patients with large myocardial perfusion defects (fixed or reversible) and presumably an ischemic etiology for their heart failure. Patients with no large or absent perfusion defects had more favorable survival outcomes.
Patients with severe coronary artery disease (CAD) and symptomatic left ventricular systolic dysfunction have poor outcomes when treated medically, even with the most recent advances in medical therapy. CAD has become the most common etiology of heart failure, with dilated cardiomyopathy and hypertensive heart disease following closely behind. Revascularization as an additional mode of therapy has not definitively been demonstrated to enhance survival in patients with severe CAD and left ventricular dysfunction in the absence of angina. Current guidelines for the treatment of patients with CAD and heart failure, therefore, reflect an uncertainty of optimal management and the outcome of patients with different etiologies of heart failure.
Severe myocardial ischemia can lead to left ventricular dysfunction, and the concept of hibernating myocardium has been established. Central to the issue of hibernating or viable myocardium is its detection and potential for reversibility. Radionuclide imaging has been well studied for its ability to identify viable myocardium. Myocardial viability has generally been assessed with quantitative perfusion imaging using thallium-201 (Tl) scintigraphy. With a few exceptions, these studies have focused on postoperative improvement in left ventricular function and not long-term patient outcome.
The purpose of this study was to assess the relationship of the findings of myocardial perfusion imaging (MPI) to long-term outcome in a large series of patients with left ventricular dysfunction and suspected myocardial ischemia. We sought to test the hypothesis that subgroups of patients with heart failure identified on the basis of MPI would have different long-term outcomes.
Background: We retrospectively identified heart failure patients with suspected ischemic heart disease who underwent myocardial perfusion imaging (MPI) to examine the relationship of MPI findings to subsequent patient outcomes.
Methods: The study group consisted of 336 patients with heart failure, left ventricular ejection fraction <45%, and suspected ischemic heart disease who underwent MPI during the period of January 1991 to December 31, 1997. Patients were divided in 3 subgroups: group A (n = 137), large fixed perfusion defects; group B (n = 77), large reversible perfusion defects; and group C (n=122), absence of a large reversible or fixed perfusion defect.
Results: Overall, the 5-year mortality rate was high at 49.2% ± 3.1%. Mortality was significantly different (P = .009) among the 3 subgroups. Groups A and B had a similar 5-year mortality rates >50%. Group C had a relatively better, but still substantial 5-year mortality rate of 40%. The overall revascularization rate was low (9.7% in 5 years).
Conclusion: These results indicate a high 5-year mortality rate in patients with large myocardial perfusion defects (fixed or reversible) and presumably an ischemic etiology for their heart failure. Patients with no large or absent perfusion defects had more favorable survival outcomes.
Patients with severe coronary artery disease (CAD) and symptomatic left ventricular systolic dysfunction have poor outcomes when treated medically, even with the most recent advances in medical therapy. CAD has become the most common etiology of heart failure, with dilated cardiomyopathy and hypertensive heart disease following closely behind. Revascularization as an additional mode of therapy has not definitively been demonstrated to enhance survival in patients with severe CAD and left ventricular dysfunction in the absence of angina. Current guidelines for the treatment of patients with CAD and heart failure, therefore, reflect an uncertainty of optimal management and the outcome of patients with different etiologies of heart failure.
Severe myocardial ischemia can lead to left ventricular dysfunction, and the concept of hibernating myocardium has been established. Central to the issue of hibernating or viable myocardium is its detection and potential for reversibility. Radionuclide imaging has been well studied for its ability to identify viable myocardium. Myocardial viability has generally been assessed with quantitative perfusion imaging using thallium-201 (Tl) scintigraphy. With a few exceptions, these studies have focused on postoperative improvement in left ventricular function and not long-term patient outcome.
The purpose of this study was to assess the relationship of the findings of myocardial perfusion imaging (MPI) to long-term outcome in a large series of patients with left ventricular dysfunction and suspected myocardial ischemia. We sought to test the hypothesis that subgroups of patients with heart failure identified on the basis of MPI would have different long-term outcomes.
Source...