Mortality risk associated with ejection fraction differs across resting nuclear perfusion findings |
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Authors: | Jamieson M. Bourque Eric J. Velazquez Robert H. Tuttle Linda K. Shaw Christopher M. O’Connor Salvador Borges-Neto |
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Affiliation: | (1) Division of Cardiology, Department of Internal Medicine, Duke University Health System, Box 3356 DUMC, 27710 Durham, NC;(2) Duke Clinical Research Institute, Duke University Health System, Durham, NC;(3) Division of Nuclear Medicine, Department of Radiology, Duke University Health System, Durham, NC |
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Abstract: | Background Left ventricular ejection fraction (LVEF) is a significant predictor of morbidity and death. The nuclear summed rest score (SRS) measures myocardial perfusion defects and provides prognostic information, but its effects on long-term outcomes are not fully established. Moreover, information regarding the potential interaction between these 2 covariates is limited. The purpose of this study was to determine whether the mortality risk associated with LVEF is the same across all values of SRS in a population undergoing evaluation for ischemic heart disease. Methods and Results We examined 3,187 patients who underwent cardiac catheterization and perfusion single photon emission computed tomography imaging with a maximum follow-up of 8.1 years and median follow-up of 3.1 years. Cox proportional hazards modeling showed that increasing nuclear SRS and decreasing LVEF were independently associated with a higher long-term mortality rate, with a clinically significant interaction between them (P=.032). Patients with a normal LVEF and a high SRS (greater perfusion abnormality) have a prognosis similar to those with a reduced LVEF. Conclusions Resting perfusion studies provide prognostic information for long-term survival and significantly impact the interpretition of mortality risk associated with changes in LVEF. Patient prognostication, risk stratification, and future research using these variables should take this interaction into account. Supported by a grant from the Tom & Lynn Royster Foundation. Durham, NC, and a National Institutes of Health Research Fellowship Grant (T5 GM08679-04), Bethesda, Md. |
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Keywords: | Myocardial perfusion imaging single photon emission computed tomography ejection fraction coronary artery disease |
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