Long-term coronary risk in relation to exercise test, SestaMIBI myocardial perfusion, lung uptake, transient ischaemic dilation and left ventricular volumes

Summary Purpose: We investigated whether the additional knowledge of lung uptake (lung-heart-ratio, LHR), transient ischaemic dilation (TID) and ungated left ventricular volumes (VOL) on top of perfusion defects (summed stress score [SSS]) derived from a single day rest-stress-technetium-99m SestaMIBI imaging protocol (sd-MPS) improves prediction of major cardiac events (MACE) in the long-term. SSS together with exercise SestaMIBI measurements provide important prognostic information. However, little is known about the incremental prognostic value of LHR, TID, and VOL. Methods: In a primary care outpatient setting, 519 patients underwent a supine bicycle electrocardiogram stress test (EST) as specified by an sd-MPS protocol. SSS, TID, and VOL were quantified with AutoQUANT (version 4.3). LHR was measured from a planar anterior image 4–6 minutes after peak exercise. The mean follow-up period was 6.1 ± 1.5 years. Results: The mean patient age was 59 ± 11 years. Of the 519 patients, 363 (70%) were male and 236 (45%) had known coronary artery disease. There were 44 major cardiac events, thereof 32 cardiac deaths and 12 nonfatal myocardial infarctions. Using Cox analysis for EST and scintigraphic variables, the independent predictors of MACE were male gender, the cardiac workload level reached during testing, and VOL. When a Cox-proportional Hazard model was used, LHR (X2 = 26.83, p = 0.04) and VOL (X2 = 69.55, p <0.001) showed a significant increase in the prognostic value over standard stress test and SSS measures. Conclusions: The strongest predictors of MACE were VOL. LHR, but not TID added incremental prognostic information to perfusion data.