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 |
|
This article has been cited by other articles:

|
 |

|
 |
 
G. J. Zoghbi, T. A. Dorfman, and A. E. Iskandrian
The Effects of Medications on Myocardial Perfusion
J. Am. Coll. Cardiol.,
August 5, 2008;
52(6):
401 - 416.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. J. Shaw, D. S. Berman, D. J. Maron, G. B. J. Mancini, S. W. Hayes, P. M. Hartigan, W. S. Weintraub, R. A. O'Rourke, M. Dada, J. A. Spertus, et al.
Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden: Results From the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial Nuclear Substudy
Circulation,
March 11, 2008;
117(10):
1283 - 1291.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. K. Min, L. Hofstra, S. V. Gurudevan, and M. D. Cerqueira
Imaging highlights of the American Heart Association 2007 scientific sessions.
J. Am. Coll. Cardiol. Img.,
March 1, 2008;
1(2):
252 - 262.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. J. Th. Wackers, D. A. Chyun, L. H. Young, G. V. Heller, A. E. Iskandrian, J. A. Davey, E. J. Barrett, R. Taillefer, S. D. Wittlin, N. Filipchuk, et al.
Resolution of Asymptomatic Myocardial Ischemia in Patients With Type 2 Diabetes in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) Study
Diabetes Care,
November 1, 2007;
30(11):
2892 - 2898.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. S. Berman, R. Hachamovitch, L. J. Shaw, J. D. Friedman, S. W. Hayes, L. E.J. Thomson, D. S. Fieno, G. Germano, N. D. Wong, X. Kang, et al.
Roles of Nuclear Cardiology, Cardiac Computed Tomography, and Cardiac Magnetic Resonance: Noninvasive Risk Stratification and a Conceptual Framework for the Selection of Noninvasive Imaging Tests in Patients with Known or Suspected Coronary Artery Disease
J. Nucl. Med.,
July 1, 2006;
47(7):
1107 - 1118.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Campisi, J. Camilletti, A. Mele, J. Erriest, P. Pedroni, and A. Guiglioni
Tibolone Improves Myocardial Perfusion in Postmenopausal Women With Ischemic Heart Disease: An Open-Label Exploratory Pilot Study
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3):
559 - 564.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. H. Stone, D. M. Lloyd-Jones, S. Kinlay, B. Frei, W. Carlson, J. Rubenstein, T. C. Andrews, M. Johnstone, G. Sopko, H. Cole, et al.
Effect of Intensive Lipid Lowering, With or Without Antioxidant Vitamins, Compared With Moderate Lipid Lowering on Myocardial Ischemia in Patients With Stable Coronary Artery Disease: The Vascular Basis for the Treatment of Myocardial Ischemia Study
Circulation,
April 12, 2005;
111(14):
1747 - 1755.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. J. Slomka, D. S. Berman, and G. Germano
Quantification of Serial Changes in Myocardial Perfusion
J. Nucl. Med.,
December 1, 2004;
45(12):
1978 - 1980.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. H Boger
Asymmetric dimethylarginine (ADMA) modulates endothelial function - therapeutic implications
Vascular Medicine,
August 1, 2003;
8(3):
149 - 151.
[PDF]
|
 |
|
|