VALIDATION OF PROGNOSTIC AND NEGATIVE PREDICTIVE VALUES OF NORMAL CARDIAC PERFUSION STUDY IN THE LOCAL POPULATION

Pa, I Ta N J O U R N A L O F R A D I O L Og, Y Maseeh Uz Zaman, Sharjeel Usmani, Kashif Niyaz, Shahid Kamal, Abid Hameed
unpublished
Corre s ponde nce : Dr. M as e e h uz Z am an H e ad, Nucl e ar M e dicine Se ction, K IRAN, Sch e m e 33, K arach i. Ph : 34646601-4 E-m ail : m z am an63@ h otm ail .com Karach i Ins titute of Radioth e rapy And Nucl e ar Me dicine (KIRAN), K arach i, Pak is tan. ade q uate s tre s s. 1-4 In Pak is tan, nucl e ar cardiol ogy w as s tarte d in th e e arl y nine tie s and s ince th an an e norm ous grow th h as be e n obs e rve d in th e l as t 15 ye ars as s e e n in th e USA and EU countrie
more » ... A and EU countrie s. To th e be s t of our k now l e dge no s tudy from Pak is tan s o far h as be e n f ound in t h e l ite rature de picting th e prognos tic val ue of a norm al cardiac pe rfus ion s can. Th e aim of th is pros pe ctive s tudy w as to e val uate th e prognos tic val ue of norm al m yocardial pe rfus ion s can in our popul ation. Th e aim of th is s tudy w as to e val uate th e prognos tic val ue of a norm al M PI in our popul ation. PATIENTS AND M ETH OD: Th is s tudy incl ude d 413 patie nts w it h norm al M PI (w it h ade q uate s tre s s) pe rform e d w it h s e s taMIBI. Out of 413 patie nts , 217 w e re m al e and 19 6 w e re f e m al e w it h m e an age 52.4 ± 9 .8 ye ars (m e dian 52 ye ars). Th e s tudy w as indicat e d for ch e s t pain diagnos is in 330 (80%) and f or th e as s e s s m e nt of functional capacity in re m aining 83 (20%) pat ie nts. Th e cardiac ris k f actors w e re pre val e nt incl uding h ype rte ns ion in 9 2 (22.3%), diabe te s in 52 (12.6%) and dys l ipide m ia in 52 (12.6%). Furth e rm ore , 21.5% patie nt s h ad >2 ris k f actors. 248 (60%) individual s unde rw e nt dynam ic s tre s s f ol l ow ing Bruce or M odif ie d Bruce Prot ocol and e nd point s w e re ach ie ve m e nt of >85% targe t h e art rate , ch e s t pain or appe arance of s ignificant ECG ch ange s. Re m aining 165 (40%) individual s h ad dipyridam ol e inte rve ntion (s tandard protocol). A s tre s s-re s t (one day protocol) SPECT s tudy w as acq uire d us ing s ingl e h e ad ECAM (Sie m e ns) or doubl e h e ad Tos h iba GCA-7200A gam m a cam e ras. Th e s e patie nts w e re fol l ow e d up f or 18 m onth s ± 5 m onth s and occurre nce s of h ard cardiac e ve nts (M I or cardiac de ath) w e re as k e d on te l e ph one. RESULTS: Th e obs e rve d cardiac de ath s w e re 3/413 (0.73%) and non-fatal M Is w e re s e e n in 4/413 (0.9 7%) on 18 m onth s fol l ow up. Th e obs e rve d cardiac m ortal ity rate f or patie nts w ith norm al M PI w as 0.73%. Ris k adjus te d (control l ing f or age , s e x and type of s tre s s) ove ral l cardiac s urvival e xce e de d 9 9 .27%. For w om e n and m e n, th e ave rage cardiac s urvival w as 9 9 % and 9 9 .5% re s pe ctive l y (p=0.001). Additional l y f or pat ie nts unde rgone e xe rcis e , th e annual iz e d s urvival rate w as 9 9 .6% and 9 8.8% for th os e w h o h ad dipyridam ol e inte rve ntion. CONCLUSION: A norm al s e s taM IBI SPECT s tudy w ith ade q uat e s tre s s is as s ociate d w it h annual iz e d cardiac de at h rat e of 0.5% and a ne gative pre dictive val ue of 9 8.33%. Furth e rm ore , th e s e s tatis tics of our popul at ion are com parabl e w ith m os t of th e publ is h e d s tudie s. K e yw ords : Norm al M yocardial Pe rfus ion Scan; Ne gative pre dictive val ue ; Prognos tic val ue ; Eve nt rate ABSTRACT Introduction
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