Prognostic Value of Normal Stress Myocardial Perfusion Imaging in Japanese Population : A Study Based on the J-ACCESS Study

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• Background In Japan, Diagnosis Procedure Combination (DPC) of hospitalization health-care costs has been introduced since 2004, and its introduction has been recently expanded also to general hospitals. In such situations, the role of nuclear cardiology as a gatekeeper for the diagnosis of ischemic heart disease is increasingly important. Thus, the present study was designed to determine which clinical risk for hard events after normal single-photon emission computed tomography (SPECT) images, identify the predictors of increased risk in patients with normal SPECT images based on the J-ACCESS study. Methods and Results A total of 4,629 consecutively tested patients who underwent stress ^<99m>Tc-tetrofosmin SPECT at hospitals in Japan were included in the study. Based on SPECT image data, 1,862 participants had a summed stress score of ≤3, which was considered normal (selection criteria I; normal perfusion). Myocardial perfusion was normal in 46.2% of the study population. Among normal SPECT subjects, cardiac function, as assessed by quantitative gated SPECT software, showed 1,786 participants were considered normal, based on left ventricular end-systolic volume (ESV) (ESV ≤60ml in men, ESV ≤40ml in women), which is defined as selection criteria II (normal perfusion and ESV). In addition, 1,742 participants were found to be normal based on ejection fraction (EF) (EF ≥49% in men, EF ≥55% in women), which is defined as selection criteria HI (normal perfusion, ESV and EF). During the 3-year follow-up period, there was a total of 211 cardiac events (11.3%) in patients grouped in selection criteria I, 196 cardiac events (11.0%) in patients grouped in selection criteria n, and 189 cardiac events in patients grouped in selection criteria III (10.8%). The annual hard event rates were 0.81%, 0.67% and 0.63% in selection criteria I, II and III, respectively. Cox proportional hazard analysis showed that diabetes mellitus, age and hypertension were independent predictors of all cardiac events in all selection criteria. Conclusion Normal stress myocardial perfusion imaging in the Japanese population is associated with a low cardiac event risk. The prognosis results of a normal SPECT scan would be useful for better patient management.

• 2008-03-20

著者

• HORIE Minoru

  Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science

• 中嶋 憲一

  金沢大学核医学診療科

• NAKAJIMA Kenichi

  Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences

• Nakajima Kenichi

  Kanazawa Univ. Hospital Kanazawa Jpn

• NISHIMURA Tsunehiko

  Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicin

• Matsuo Shinro

  Department of Nuclear Medicine, Kanazawa University Hospital

• Nakae Ichiro

  Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science

• Nagaoka Iori

  滋賀医科大学 呼吸循環器内科

• Nagaoka Iori

  Dep. Of Cardiovascular Medicine Shiga Univ. Of Medical Sci. Jpn

• Nagaoka Iori

  Department Of Cardiovascular And Respiratory Medicine Shiga University Of Medical Science

• Matsuo S

  Department Of Nuclear Medicine Kanazawa University Hospital

• Matsuo Shinro

  滋賀医科大学 内科学第一

• Matsuo Shinro

  滋賀医科大学 呼吸循環器内科

• Matsuo Shinro

  Kanazawa Univ. Hospital Kanazawa Jpn

• Matsuo Shinro

  Department Of Nuclear Medicine Kanazawa University Hospital

• Matsuo Shinro

  Department Of Cardiovascular And Respiratory Medicine Shiga University Of Medical Science

• Matsuo Shinro

  日本大学 医学部循環器内科部門

• 西村 恒彦

  京都府立医科大学大学院放射線診断治療学

• NISHIKAGE Tomoko

  Acuson Nippon K.K.

• Nishimura T

  Department Of Radiology Graduate School Of Medical Sciences Kyoto Prefectural University Of Medicine

• Nishimura Tsunehiko

  大阪大学 トレーサ情報解析

• Nishimura Tsunehiko

  Department Of Radiology Graduate School Of Medical Science Kyoto Prefectural University Of Medicine

• Nakajima Kenichi

  Department Of Nuclear Medicine Kanazawa University Hospital

• Nakae Ichiro

  Department Of Cardiovascular And Respiratory Medicine Shiga University Of Medical Science

• Nishimura T

  Department Of Radiology Graduate School Of Medical Science Kyoto Prefectural University Of Medicine

• Nishimura Tsunehiko

  Department Of Radiology Kyoto Prefectural University Of Medicine Graduate School Of Medical Science

• Nakajima Kenichi

  Kanazawa Univ. Kanazawa Jpn

• Mitamura Hideo

  Division Of Cardiology Tokyo Saiseikai Central Hospital

• Horie Minoru

  Department Of Cardiopulmonary Medicine Shiga University Of Medical Science

• Nakajima Ken-ichi

  Department Of Nuclear Medicine Kanazawa University Hospital

• Nakae Ichiro

  Department Of Internal Medicine Shiga University Of Medical Science

• Nishimura Tsunehiko

  Dept. Of Radiology And Artificial Organs National Cardiovascular Center

• Horie Minoru

  Department Of Cardiac Physiology National Cardiovascular Center Research Institute

• Nishimura Tunehiko

  Department Radiology National Cardiovasucular Center

• Nakae Ichiro

  Division Of Cardiology Internal Medicine Shiga University Of Medical Science

• Hojho Mayumi

  Department Of Circulation Research Institute Of Environmental Medicine

• Nishimura Tsunehiko

  Radiology National Cardiovascular Center

• Matsuo Shinro

  Division Of Cardiology Department Of Medicine Shiga University Of Medical Science

• Nakajima Kenichi

  Department Of Nuclear Medicine

• Matsuo Shinro

  滋賀医科大学 1内

• Nishikimi Toshio

  The Division Of Hypertension National Cardiovascular Center

• Nishikage Tomoko

  Division Of Hypertension And Cardiorenal Disease Dokkyo University School Of Medicine

• Nakajima Kenichi

  金沢大学附属病院 核医学

• Nishikimi Toshio

  Acuson Nippon K.k.

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