Olakunle O. Akinboboye

Long-Term Outcome of Patients With Intermediate-Risk Exercise Electrocardiograms Who Do Not Have Myocardial Perfusion Defects on Radionuclide Imaging

BACKGROUND The appropriate management of patients with intermediate-risk Duke treadmill scores is not established. The purpose of this study was to determine the long-term risk of subsequent cardiovascular events in patients with an intermediate-risk treadmill score who do not have myocardial perfusion defects on radionuclide imaging. METHODS AND RESULTS The existing databases of the nuclear cardiology laboratories of 4 academic institutions were searched retrospectively. A total of 4649 patients were identified who had intermediate-risk Duke treadmill scores (-10 to 4), normal or near-normal exercise single photon-emission computed tomographic myocardial perfusion images using either thallium-201 or technetium-99m sestamibi, and no previous coronary revascularization. Follow-up was 95% complete. Cardiovascular survival was 99.8% at 1 year, 99.0% at 5 years, and 98.5% at 7 years. Cardiac survival free of myocardial infarction was similarly high at 96.6% at 7 years. Cardiac survival free of myocardial infarction or revascularization was 87.1% at 7 years. Near-normal scans and cardiac enlargement were independent predictors of time to cardiac death. Seven-year cardiac survival was still high at 97.0% in the 357 patients with near-normal scans and normal cardiac size and somewhat lower, at 89.0%, in the 167 patients with cardiac enlargement. CONCLUSIONS Patients with an intermediate-risk treadmill score but with normal or near-normal exercise myocardial perfusion images and normal cardiac sizes are at low risk for subsequent cardiac death and can be safely managed medically until their symptoms warrant revascularization. The appropriate management of patients with cardiac enlargement will remain a matter of clinical judgment.

Utility of positron emission tomography in predicting cardiac events and survival in patients with coronary artery disease and severe left ventricular dysfunction.

that many patients referred for transplantation can actually safely undergo coronary artery bypass grafting if they have viable myocardium identified with positron emission tomography (PET). The delineation of viable from nonviable myocardium is critically important, especially in patients with severe left ventricular (LV) dysfunction because they derive the most benefit from surgical interventions, but also have the highest perioperative risk. 4‐ 7 The purpose of this study was to determine the utility of PET in predicting cardiac events in patients with coronary artery disease and severe LV dysfunction and the outcome of these patients based on the choice of medical therapy or revascularization. ••• A retrospective analysis of all patients who had

Usefulness of positron emission tomography in defining myocardial viability in patients referred for cardiac transplantation

Positron emission tomography imaging detected evidence of viability in 17 of 33 patients with evidence of infarction only on their thallium scans who were referred for transplant evaluation. Eleven of these 17 underwent revascularization with excellent outcome.