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  • Title: Prognostic value of normal stress myocardial perfusion imaging in Japanese population.
    Author: Matsuo S, Nakajima K, Horie M, Nakae I, Nishimura T, J-ACCESS Investigators.
    Journal: Circ J; 2008 Apr; 72(4):611-7. PubMed ID: 18362434.
    Abstract:
    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 <or=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 <or=60 ml in men, ESV <or=40 ml 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 >or=49% in men, EF >or=55% in women), which is defined as selection criteria III (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 II, 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.
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