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CLINICAL RESEARCH: CLINICAL TRIAL

Prospective serial evaluation of myocardial perfusion and lipids during the first six months of pravastatin therapy

Coronary artery disease regression single photon emission computed tomography monitoring trial

Ronald G. Schwartz, MD, MS, FACC^*,*, Thomas A. Pearson, MD, PhD, FACC^*, Vijay G. Kalaria, MD, FACC, Maria L. Mackin, CNMT^*, Daniel J. Williford, MD, PhD, FACC^*, Ashish Awasthi, MD^*, Abrar Shah, MD^*, Adam Rains, MSc^* and Joseph J. Guido, MS^*

^* Cardiology Unit, Department of Medicine; Division of Nuclear Medicine, Department of Diagnostic Radiology; and the Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
Krannert Institute of Cardiology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA

Manuscript received November 5, 2002; revised manuscript received January 30, 2003, accepted March 12, 2003.

^* Reprint requests and correspondence: Dr. Ronald G. Schwartz, University of Rochester Medical Center, Cardiology Unit, Box 679, 601 Elmwood Avenue, Rochester, New York 14642-8679, USA.
Ronald_Schwartz{at}URMC.Rochester.edu

This work was presented in part at the 50th Annual Scientific Session of the American College of Cardiology, March 2001, Orlando, Florida.

OBJECTIVES: This study was designed to assess prospectively changes in serum lipid profile and myocardial perfusion with serial radionuclide single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) during the first six months of pravastatin therapy.

BACKGROUND: Morbid coronary events occur despite statin therapy and lipid-lowering in patients with coronary artery disease (CAD). A reliable strategy to identify responders with effective treatment from nonresponders on statin therapy before clinical events is needed.

METHODS: Rest and stress SPECT MPI and lipids were assessed serially in 25 patients (36% women) with CAD and dyslipidemia during the first six months of pravastatin therapy.

RESULTS: Total cholesterol, low-density lipoprotein cholesterol, and triglycerides declined (26%, 32%, and 30%, respectively) by six weeks and remained reduced at six months. Mean stress perfusion defect (summed stress score [SSS]) was severe (13.3 ± 6.0) at baseline, showed no change at six weeks, and improved significantly at six months (10.3 ± 7.3, p < 0.01). The six-month study SSS improved in 11 (48%) patients, was unchanged in 10 (43%) patients, and worsened in 2 (9%) patients. Changes in lipid levels did not reliably predict changes in myocardial perfusion at six weeks or six months in this small pilot study.

CONCLUSIONS: Serial SPECT MPI demonstrated improved stress myocardial perfusion in 48% of patients treated for six months with pravastatin. Time course of improved myocardial perfusion during pravastatin therapy is delayed compared to lipids. Direction and magnitude of changes in the myocardial perfusion vary and do not correlate closely with improvements in lipids.

Abbreviations and Acronyms   CAD   coronary artery disease   HDL   high-density lipoprotein   LDL   low-density lipoprotein   LV   left ventricular   MPI   myocardial perfusion imaging   PET   positron emission tomography   SDS   summed difference score   SPECT   single photon emission computed tomography   SRS   summed rest score   SSS   summed stress score   TC   total cholesterol

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