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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

View larger version (399K): [in a new window]   Figure 1 (A to C) Single photon emission computed tomography myocardial perfusion imaging orthogonal plane images before pravastatin therapy (baseline), at six weeks, and at six months of pravastatin therapy in a typical patient with reduced summed stress score by six months. Consistent with randomized controlled trials, pravastatin 40 mg was administered on a non-dose titrated basis. Stress perfusion defect size declined in 11 (48%) and was stable in 10 (43%) of 23 patients completing the trial. (D) Automated quantitative analyses of defect (percent of left ventricular hypoperfusion) size (left images) and global extent (right images) at baseline, six weeks, and six months of pravastatin therapy. Quantitative analyses verified improved average stress perfusion by six months in the study population.

View larger version (51K): [in a new window]   Figure 2 (A) Single photon emission computed tomography (SPECT) summed stress score (SSS) and summed difference score (SDS) (SDS = SSS – summed rest score [SRS]) of myocardial perfusion abnormalities at baseline and six months are compared. Significant reductions in these perfusion indices were observed. In contrast, SSS was not reduced at six weeks. The SRS did not change during the study (see text). Lines track individual patient values from baseline to the six-month study. (B) Automated analyses of the stress SPECT myocardial perfusion defect size and topographic extent quantified by percent of LV hypoperfusion, using the Yale Wackers-Liu software program. Similar to the SSS, no differences were found between baseline and six-week studies (not shown). Lines track individual patient values from baseline to the six-month study.