TY - JOUR
T1 - The differing prognostic utility of exercise radionuclide ventriculography in coronary artery disease patients with and without prior myocardial infarction
AU - Moriel, Mady
AU - Rozanski, Alan
AU - Klein, Jacob
AU - Berman, Daniel S.
AU - Bairey Merz, C. Noel
N1 - Funding Information:
This work was supported in part by grants from the Division of Cardiology, Department of Medicine, and the Division of Nuclear Cardiology, Department of Nuclear Medicine, Cedars-Sinai Medical Center; the John D. and Catherine T. MacArthur Foundation; the National Institutes of Health Specialized Center for Research, grant no. 17651; and the National Heart, Lung and Blood Institutes, grant no. 232HL07380. Drs. Moriel and Klein were supported by the Save A Heart Foundation, Los Angeles, California. We thank Susan Chao, M.S. for statistical assistance.
PY - 1997
Y1 - 1997
N2 - Previous studies have documented the prognostic utility of left ventricular ejection fraction response to exercise primarily in populations without prior myocardial infarction. We undertook a study to assess the prognostic utility of exercise left ventricular ejection fraction and segmental wall motion response during exercise radionuclide ventriculography in coronary artery disease patients with and without prior myocardial infarction. Methods. We examined the comparative prognostic utility of left ventricular ejection fraction and segmental wall motion response during upright bicycle exercise radionuclide ventriculography in 419 coronary artery disease patients with (n=217) and without (n=202) prior myocardial infarction using univariate and multivariate hierarchical regression analyses. Results. During an average followup period of 61 months, 96 patients (23%) suffered cardiac events, including 55/217 (25%) of the patients with prior myocardial infarction and 41/200 (21%) of the patients without prior myocardial infarction (p=ns). Both cumulative Kaplan-Meier survival analyses and stepwise hierarchical Cox survival analyses demonstrated that peak left ventricular ejection fraction <55% was a significant predictor of cardiac events in patients without prior myocardial infarction (p=0.04), whereas an exercise wall motion worsening score ≥2 was a significant predictor in patients with a prior myocardial infarction (p=0.0001). Conclusions. The prognostic utility of exercise radionuclide ventriculography variables differ according to the presence or absence of prior myocardial infarction. Global function, assessed by peak left ventricular ejection fraction, adds the greatest prognostic information in patients without prior myocardial infarction, whereas regional function, assessed by exercise wall motion worsening, is the best predictor among patients with prior myocardial infarction.
AB - Previous studies have documented the prognostic utility of left ventricular ejection fraction response to exercise primarily in populations without prior myocardial infarction. We undertook a study to assess the prognostic utility of exercise left ventricular ejection fraction and segmental wall motion response during exercise radionuclide ventriculography in coronary artery disease patients with and without prior myocardial infarction. Methods. We examined the comparative prognostic utility of left ventricular ejection fraction and segmental wall motion response during upright bicycle exercise radionuclide ventriculography in 419 coronary artery disease patients with (n=217) and without (n=202) prior myocardial infarction using univariate and multivariate hierarchical regression analyses. Results. During an average followup period of 61 months, 96 patients (23%) suffered cardiac events, including 55/217 (25%) of the patients with prior myocardial infarction and 41/200 (21%) of the patients without prior myocardial infarction (p=ns). Both cumulative Kaplan-Meier survival analyses and stepwise hierarchical Cox survival analyses demonstrated that peak left ventricular ejection fraction <55% was a significant predictor of cardiac events in patients without prior myocardial infarction (p=0.04), whereas an exercise wall motion worsening score ≥2 was a significant predictor in patients with a prior myocardial infarction (p=0.0001). Conclusions. The prognostic utility of exercise radionuclide ventriculography variables differ according to the presence or absence of prior myocardial infarction. Global function, assessed by peak left ventricular ejection fraction, adds the greatest prognostic information in patients without prior myocardial infarction, whereas regional function, assessed by exercise wall motion worsening, is the best predictor among patients with prior myocardial infarction.
KW - Exercise radionuclide ventriculography
KW - Prognosis
UR - https://www.scopus.com/pages/publications/0030819830
U2 - 10.1023/A:1005751510034
DO - 10.1023/A:1005751510034
M3 - Article
C2 - 9360177
AN - SCOPUS:0030819830
SN - 0167-9899
VL - 13
SP - 403
EP - 413
JO - International Journal of Cardiac Imaging
JF - International Journal of Cardiac Imaging
IS - 5
ER -