Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
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The role of coronary artery calcification (CAC) detection in individuals undergoing medical therapy is controversial. These patients frequently exhibit an artificially low clinical suspicion for obstructive heart disease. Whether detection of CAC adds value to their assessment is unknown. ⋯ The presence of a CAC score greater than 400 is associated with ischemia in a population receiving good medical therapy. The detection of significant CAC in these individuals warrants additional evaluation for ischemia.
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Randomized Controlled Trial
A randomized trial of exercise treadmill ECG versus stress SPECT myocardial perfusion imaging as an initial diagnostic strategy in stable patients with chest pain and suspected CAD: cost analysis.
Exercise electrocardiography (ETT) is frequently used in patients with suspected coronary artery disease (CAD). Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) improves diagnostic stratification. There are no randomized trials comparing ETT and MPI. We hypothesized that first-line MPI would be effective and cost-saving versus ETT. ⋯ In this study there was no difference in cost to diagnosis between initial ETT and MPI. In low-likelihood patients ETT was less costly, whereas there was no cost difference in intermediate- or high-likelihood patients.
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Controlled Clinical Trial
Prognostic value of poststress left ventricular volume and ejection fraction by gated myocardial perfusion SPECT in women and men: gender-related differences in normal limits and outcomes.
Whether there are gender differences in the prognostic application of gated myocardial perfusion single photon emission computed tomography (SPECT) has not been assessed. ⋯ Poststress EF and ESV index by gated myocardial perfusion SPECT provide comparable incremental prognostic information over perfusion in women and men. After separate criteria for abnormal EF and ESV index in women are used, the combination of severe ischemia and abnormal EF or ESV index identifies women at very high risk of cardiac events.