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Etiology and pathophysiology of new-onset heart failure: Evaluation by myocardial perfusion imaging |
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| Authors: | Prem Soman MD PhD FRCP Avijit Lahiri MD Jennifer H. Mieres MD Dennis A. Calnon MD David Wolinsky MD George A. Beller MD Tina Sias MD Kenneth Burnham MD Laurence Conway MD Peter A. McCullough MD Edouard Daher MD Mary N. Walsh MD Joseph Wight MD Gary V. Heller MD PhD James E. Udelson MD |
| Affiliation: | 1. Nuclear Cardiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, A-429 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, 15213, USA 2. The Wellington Hospital, London, United Kingdom 3. New York University School of Medicine, New York, NY, USA 4. Mid Ohio Cardiology Research Foundation, Columbus, OH, USA 5. Albany Associates in Cardiology, Albany, NY, USA 6. University of Virginia, Charlottesville, VA, USA 7. Marshall University School of Medicine, Huntington, WV, USA 8. Cardiology Associates of Mobile, Mobile, AL, USA 9. Lawrence Memorial Hospital, Tufts University, Boston, MA, USA 10. William Beaumont Hospital, Royal Oak, MI, USA 11. Wayne State University School of Medicine, Detroit, MI, USA 12. The Care Group, Indianapolis, IN, USA 13. Maine Cardiology Associates, South Portland, ME, USA 14. Hartford Hospital, University of Connecticut, Hartford, CT, USA 15. Tufts Medical Center, Boston, MA, USA |
| Abstract: | Objective The IMAGING in Heart Failure study was a prospective, multi-national trial designed to explore the role of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) as an initial investigative strategy in patients hospitalized with new-onset heart failure. Methods We recruited 201 patients (age 65.3 ± 14.5 years, 43% women) hospitalized with their first episode of heart failure. Rest/stress gated SPECT Tc-99m sestamibi MPI was performed during or within 2 weeks of the index hospitalization, in addition to standard care. Results SPECT MPI revealed a broad range of ejection fractions with preserved systolic function in 36% of patients. Forty-one percent of patients had normal perfusion. In the remaining patients, perfusion abnormalities were predominantly due to prior myocardial infarction, with extensive ischemia seen only in 6%. Among patients who underwent coronary angiography, SPECT performance characteristics revealed excellent negative predictive value (96%) for extensive coronary artery disease (CAD). In multivariable analyses, the extent of perfusion abnormality and advancing age predicted the presence of extensive CAD. Conclusions These preliminary data derived from a non-randomized observational cohort suggest potential diagnostic utility of MPI for ischemic LV dysfunction in new-onset HF, and sets the stage for a prospective randomized study to confirm these findings. The results were presented in part at the 2004 Annual Scientific Sessions of the American Society of Nuclear Cardiology, and the American College of Cardiology. |
| Keywords: | Heart failure myocardial perfusion imaging: SPECT sestamibi gated SPECT |
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