Comparative Impact of Scintigraphic Parameters and B-Type Natriuretic Peptide for the Prediction of Major Cardiac Events in the QGS-Prognostic Value in the Elderly (Q-PROVE) Study

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Background: Although B-type natriuretic peptide (BNP) has emerged as an important predictor for cardiac events, its effect on scintigraphic parameters is unknown. Methods and Results: The Q-PROVE study is a multicenter study to evaluate the prognostic value of ECG-gated SPECT in 175 Japanese elderly patients. In addition, BNP was assessed in 102 patients. Outcome assessment included cardiac events and noncardiac deaths. Twelve elderly patients (12%) had increased BNP >130 pg/ml. The summed stress score (SSS) was greater in patients with increased BNP than in those with normal BNP. Kaplan-Meier survival estimation indicated event-free survival rates at 3 years of 83%, 78%, 88%, 80%, respectively, in patients with BNP >130 pg/ml, SSS ≥7, summed difference score (SDS) ≥2, and dilated end-diastolic volume (EDV), but 98%, 98%, 100%, 94% in those with BNP ≤130 pg/ml, SSS <7, SDS <2 and normal EDV (P=0.006, P=0.005, P=0.0008, P=0.01). Multivariate analysis demonstrated that an SDS was the only independent predictor for subsequent cardiac events (hazard ratio =4.0, P=0.04). Conclusions: Although BNP may have similar prognostic value to gated SPECT volumetric measurements in elderly patients with known or suspected coronary artery disease, myocardial ischemia as documented by SPECT is still indispensable for detecting high-risk patients compared with BNP alone.
2009-08-20