Valor pronóstico de los estudios de perfusión miocárdica normal con 99mTc-MIBI en pacientes con prueba de esfuerzo positiva / Prognostic value of a normal myocardial perfusion SPECT in patients with positive exercise tests

El estudio de perfusión miocárdica (EPM) es una modalidad no invasiva en la evaluación de la cardiopatía isquémica, una de las primeras causas de morbi-mortalidad a nivel mundial. Nuestro objetivo fue describir el valor pronóstico del EPM normal con 99m Tc-MIBI en pacientes con prueba de esfuerzo positiva y riesgo cardiovascular variable. MétodoEs un estudio descriptivo, retrospectivo. Se revisaron las historias clínicas y se estableció contacto vía telefónica con los pacientes, con un seguimiento medio de 42,4 meses. Resultados Se incluyeron 74 pacientes, 41 mujeres y 33 varones, con edad promedio de 58 años. La mayoría presentaba más de tres factores de riesgo para enfermedad coronaria. La clasificación de riesgo de Framingham mostró 9,5 por ciento de bajo riesgo, 54,1 por ciento de riesgo moderado y 36,5 por ciento de alto riesgo. La FEVI media fue de 59,41 por ciento. El 98,7 por ciento de los pacientes no presentaron eventos cardíacos durante el seguimiento; 3 pacientes persistían con dolor torácico que se interpretó como de origen no coronario y un paciente presentó un evento cardíaco menor. No hubo relación estadísticamente significativa al asociar edad, género, clasificación de riesgo y periodo libre de eventos. Conclusiones El EPM constituye una valiosa herramienta de diagnóstico y pronóstico en cardiopatía isquémica, por su alto valor predicitivo negativo aún en pacientes con prueba ergométrica positiva.

Introduction Myocardial perfusion SPECT (MPS) is a noninvasive modality for the evaluation of ischemic heart disease, one leading causes of morbidity and mortality worldwide. Our objective was to evaluate the prognostic value of a normal MPS in patients with positive exercise tests. Methods This is a descriptive, retrospective study. We reviewed the medical records and telephone contact was established with patients. Results We included 74 patients, 41 women and 33 men, average age 58 years. Most patients had more than 3 risk factors for coronary heart disease. The Framingham risk classification showed 9.5 percent of low risk, 54.1 percent moderate and 36.5 percent high risk. The mean follow uwas 42.4 months; 98.7 percent of patients had no cardiac events during follow u; 3 patients persisted with chest pain considered non-coronary, and one patient had a minor cardiac event. The mean LVEF was 59.41 percent. There was no statistically significant relationshibetween age, gender, risk classification and event-free period. Conclusions MPS is a valuable tool for diagnosis and prognosis in ischemic heart disease because of its high negative predictive value even in patients with positive exercise stress test.

Prognostic Implication of Normal Myocardial Perfusion Scintigraphy in Patients with Chest Pain / 대한핵의학회잡지

Myocardial scintigraphy is a widely used noninvasive procedure with high sensitivity for the detection of patients with suspected coronary artery disease. The purpose of this study was to determine the prognostic value of a normal myocardial scintigraphy in 292 patients (150 males, 142 females, mean age 53+/-12 years) with chest pain who were followed from 7 to 58 (mean 25) months. Myocardial SPECT was performed with Tc-99m MIBI in 173 patients, with Tc-99m tetrofosmin in 74 patients and with T1-201 in 45 patients. During the follow-up period, there were 2 cardiac deaths and 2 nonfatal myocardial infarctions resulting in cardiac event rate of 1.37% (0.66% per year). The cardiac event rate was not different in patients with angiographically normal coronary arteries (1/30, 3.3%) and in those who had significant coronary a disease (2/27, 7.4%) (p=0.60). In conclusion, patients with chest pain and normal myocardial scintigraphy have a low cardiac event rate, and there was no significant difference of cardiac event rates between patients with normal and abnormal coronary angiograms.