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Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography

Aiden Abidov, MD, PhD^*, Rory Hachamovitch, MD, MSc, FACC, Alan Rozanski, MD, Sean W. Hayes, MD^*, Marcia M. Santos, MD^*, Maria G. Sciammarella, MD^*, Ishac Cohen, PhD^*, James Gerlach, CNMT^*, John D. Friedman, MD^*, Guido Germano, PhD, FACC^* and Daniel S. Berman, MD, FACC^*,*

Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, CaliforniaUSA
Cardiovascular Division, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CaliforniaUSA
Division of Cardiology, St. Luke's Roosevelt Hospital Center, New York, New YorkUSA

View larger version (14K): [in a new window]   Figure 1 Prevalence of atrial fibrillation (AF) in the study population as a function of age. *p < 0.001 across groups. Solid bars = percentage of AF patients.

View larger version (18K): [in a new window]   Figure 2 Myocardial perfusion single-photon emission computed tomography results in the study population. *p = 0.007; **p = 0.002 compared with non-atrial fibrillation (AF) patients. % Myo fixed = % myocardium hypoperfused at rest (from summed rest score); % Myo ischemic = % myocardium ischemic (from summed difference perfusion score); % Myo stress = % myocardium hypoperfused at stress (from summed stress score). Solid bars = AF; open bars = non-AF.

View larger version (23K): [in a new window]   Figure 3 Unadjusted cardiac death (CD) rates in patients with atrial fibrillation (AF) compared with non-AF patients as a function of myocardial perfusion single-photon emission computed tomography results. *p < 0.001. abnl = abnormal; Mod-Sev = moderately to severely; MPS = myocardial perfusion single-photon emission computed tomography; % Myo Stress = % myocardium hypoperfused at stress (from summed stress score). Solid bars = AF patients; open bars = non-AF patients.

View larger version (17K): [in a new window]   Figure 4 Risk-adjusted cardiac death (CD)-free survival curves of patients with atrial fibrillation (AF) compared with non-AF patients. Solid lines = AF patients; dotted lines = non-AF patients. 1 = non-AF patients with normal myocardial perfusion single-photon emission computed tomography (MPS); 2 = AF patients with normal MPS; 3 = non-AF patients with abnormal MPS; 4 = AF patients with abnormal MPS.

View larger version (13K): [in a new window]   Figure 5 Unadjusted cardiac death (CD) rates in patients with atrial fibrillation (AF) compared with non-AF patients as a function of left ventricular ejection fraction. *p = 0.001. EF = ejection fraction. Solid bars = AF patients; open bars = non-AF patients.

View larger version (21K): [in a new window]   Figure 6 Incremental prognostic value of chronic atrial fibrillation (AF) in predicting cardiac death over clinical variables (*age, type of stress, resting heart rate, diabetes, and shortness of breath), nuclear variables (% myocardium hypoperfused at rest [% Myo fixed] and % myocardium ischemic [% Myo ischemic]), left ventricular ejection function ([LVEF] *including the interaction LVEF x shortness of breath). Added to all these most significant variables, AF provided additional significant gain in global chi-square, compared with the previous step.