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CLINICAL RESEARCH: CARDIAC IMAGING

Prognostic Value of Lung Sestamibi Uptake in Myocardial Perfusion Imaging of Patients With Known or Suspected Coronary Artery Disease

William D. Leslie, MD, MSc^_*,_*, Shawn A. Tully, MD^_*, Marina S. Yogendran, MSc, Linda M. Ward, RT(NM)^_*, Khaled A. Nour, MD^_* and Colleen J. Metge, PhD

^_* Department of Nuclear Medicine, St. Boniface General Hospital, Winnipeg, Canada
Manitoba Centre for Health Policy, Winnipeg, Canada.

Manuscript received June 24, 2004; revised manuscript received February 3, 2005, accepted February 8, 2005.

^_* Reprint requests and correspondence: Dr. William D. Leslie, Department of Medicine (C5121), 409 Tache Avenue, Winnipeg, Canada R2H 2A6. (Email: bleslie{at}sbgh.mb.ca).

OBJECTIVES: We sought to determine whether lung uptake of technetium-99m (^99mTc)-based myocardial perfusion tracers predicts cardiac events.

BACKGROUND: Increased lung uptake of thallium-201 during myocardial perfusion scintigraphy can predict important clinical outcomes. It is unclear whether lung uptake of ^99mTc-based myocardial perfusion tracers can be used in a similar way.

METHODS: Stress lung-to-heart ratio (sLHR) was determined in 718 patients undergoing ^99mTc-sestamibi single-photon emission computed tomographic stress imaging. The primary outcome was acute myocardial infarction or death.

RESULTS: During a mean follow-up of 5.6 years, a primary end point occurred in 114 patients (16%). The sLHR was significantly greater in those with an adverse outcome (p < 0.00001). The likelihood of an adverse outcome increased by a factor of 1.5 (95% confidence interval 1.2 to 1.7) for each standard deviation increase in sLHR after adjustment for all other variables. The sLHR provided a small but significant improvement in risk stratification when added to clinical, stress test, perfusion, and left ventricular volume information (global chi-square 168.6 vs. 150.7, p < 0.00001).

CONCLUSIONS: Stress LHR is an adjunctive prognostic measure in patients with known or suspected coronary artery disease.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   dLHR = difference in lung-to-heart ratios   LHR = lung-to-heart ratio   LV = left ventricle   rLHR = rest lung-to-heart ratio   SDS = summed difference score   sLHR = stress lung-to-heart ratio   SPECT = single-photon emission computed tomography   SRS = summed rest score   SSS = summed stress score   201Tl = thallium-201   99mTc = technetium-99m

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