CLINICAL RESEARCH: NUCLEAR IMAGING
Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
Leslee J. Shaw, PhD*,*,
Robert C. Hendel, MD ,
Manuel Cerquiera, MD ,
Jennifer H. Mieres, MD ,
Naomi Alazraki, MD||,
Elizabeth Krawczynska, MD||,
Salvador Borges-Neto, MD¶,
Jamshid Maddahi, MD# and
C. Noel Bairey Merz, MD*
* Cedars-Sinai Medical Center, Los Angeles, California
Midwest Heart Specialists, Fox River Grove, Illinois
Cleveland Clinic Foundation, Cleveland, Ohio
North Shore University, Long Island Jewish Health System, Long Island, New York
|| Emory University, Atlanta VA Medical Center, Atlanta, Georgia
¶ Duke University, Durham, North Carolina
# UCLA Medical Center, Los Angeles, California.
Manuscript received December 29, 2003;
revised manuscript received January 11, 2005,
accepted January 25, 2005.
* Reprint requests and correspondence: Dr. Leslee J. Shaw, Taper Building, Room 125, 8700 Beverly Boulevard, Cedars-Sinai Medical Center, Los Angeles, California 90048. (Email: leslee.shaw{at}cshs.org).
Preliminary findings from this report were presented at the Annual Scientific Sessions of the American Heart Association in Orlando, Florida, November 2003.
OBJECTIVES: This study was designed to evaluate the differential prognostic value of gated single-photon emission computed tomographic imaging (SPECT) imaging in an ethnically diverse multicenter registry.
BACKGROUND: Ethnic minority patient populations have reportedly higher coronary heart disease mortality with greater comorbidity and a clustering of risk factors at a significantly younger age when compared with Caucasian, non-Hispanic patients. Despite our increasingly diverse population, the predictive accuracy of cardiac imaging in ethnic minority patients is ill-defined.
METHODS: A total of 7,849 patients were prospectively enrolled in a registry of patients undergoing exercise (44%) or pharmacologic stress (56%) technetium-99m tetrofosmin SPECT. Scans were scored using a 20-segment myocardial model with a 5-point severity index. Multivariable Cox proportional hazards models were employed to assess time to death or myocardial infarction.
RESULTS: A total of 1,993 African-American, 464 Hispanic, and 5,258 Caucasian non-Hispanic patients underwent SPECT imaging. African-American and Hispanic patients more often had a history of stroke, peripheral arterial disease, angina, heart failure, diabetes, hypertension, and smoking at a younger age. Moderate or severely abnormal SPECT scans were noted in 21%, 17%, and 13% of African-American, Hispanic, and Caucasian non-Hispanic patients, respectively (p < 0.0001). Cardiovascular death rates were highest for ethnic minority patients (p < 0.0001). Annual rates of ischemic heart disease death ranged from 0.2% to 3.0% for Caucasian non-Hispanic and 0.8% to 6.5% for African-American patients with low-risk to severely abnormal SPECT scans (p < 0.0001). For post-stress ejection fraction <45%, annualized risk-adjusted death rates were 2.7% for Caucasian non-Hispanic patients versus 8.0% and 14.0% for African-American and Hispanic patients (p < 0.0001).
CONCLUSIONS: The current results from a large observational registry reveal that exercise and pharmacologic stress SPECT effectively predicts major cardiovascular events in a large cohort of African-American and Hispanic patients evaluated for suspected myocardial ischemia. These results provide further evidence that ethnic minority patient populations have a worsening outcome related to cardiovascular disease.
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Abbreviations and Acronyms
| | EF = ejection fraction | | MI = myocardial infarction | | SPECT = single-photon emission computed tomographic imaging | | Tc = technetium | | Tl = thallium |
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