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Myocardial Ischemia - Nuclear Medicine and Risk Stratification: Multimedia
Updated: Feb 12, 2008
Multimedia
 | Media file 1: The risk of coronary artery disease (CAD) can quickly be stratified by determining whether the patient's pain is nonanginal, atypical, or typical. For men in their 30s with nonanginal chest pain, the pretest probability of disease is approximately 5%; however, men in their 30s with typical chest pain have a 70% likelihood of disease (a 14-fold increase). |
 | Media file 2: In women, the risk of CAD can quickly be stratified on the basis of the type of chest pain. For example, a woman in her 50s with nonanginal chest pain has a pretest probability of disease of approximately 10%, whereas a woman in her 50s with typical chest pain has a pretest likelihood of approximately 80%; this rate is an 8-fold increase. |
 | Media file 3: An exercise stress test is inadequate for excluding CAD when the pretest probability of disease is intermediate to high. Of 1000 American men older than 60 years who have nonanginal chest pain, the exercise stress test causes clinicians to miss almost one third of CAD cases. |
 | Media file 4: Adding nuclear cardiac imaging to the stress ECG test greatly increases the clinical value of the test. Of 1000 American men older than 60 years who have nonanginal chest pain, CAD is misdiagnosed in 25 of the 281 men who have the disease; however, of these 25 patients, the annual rate of severe cardiac events (myocardial infarction or cardiac death) is still less than 1% per year. |
 | Media file 5: Normal perfusion on a single-photon emission computed tomography (SPECT) perfusion study. |
 | Media file 6: A SPECT perfusion study in a patient with a large degree of tracer redistribution affecting the left anterior descending and right coronary artery territories. |
 | Media file 7: This study in a patient with normal findings on myocardial perfusion scanning represents the value of gated imaging in nuclear cardiac scans. The gated images show akinesis of the distal anterior wall along with a reduced left ventricular ejection fraction and an elevated end-systolic volume. |
 | Media file 8: Polar maps can help identify abnormal findings on nuclear cardiac images. The polar map shows fairly good end-diastolic perfusion, a decreased regional ejection fraction and motion by the septum, and fairly normal thickening. |
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References
Kapetanopoulos A, Ahlberg AW, Taub CC, Katten DM, Heller GV. Regional wall-motion abnormalities on post-stress electrocardiographic-gated technetium-99m sestamibi single-photon emission computed tomography imaging predict cardiac events. J Nucl Cardiol. Nov-Dec 2007;14(6):810-7. [Medline].
Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. Jun 14 1979;300(24):1350-8. [Medline].
Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. May 12 1998;97(18):1837-47. [Medline]. [Full Text].
Mark DB, Hlatky MA, Harrell FE Jr, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. Jun 1987;106(6):793-800. [Medline].
Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. Sep 19 1991;325(12):849-53. [Medline].
Baghdasarian SB, Heller GV. Patient preparation for nuclear imaging: when should anti-ischemic medications be withheld?. J Nucl Cardiol. Nov-Dec 2007;14(6):775-81. [Medline].
Berman DS, Germano G. An approach to the interpretation and reporting of gated myocardial perfusion SPECT. In: Germano G, Berman DS, eds. Clinical Gated Cardiac SPECT. Armonk, NY: Futura Publishing Co; 1999:147-82.
Berman DS, Germano G. Nuclear cardiology: where do we stand? Part 1. Available online at www.fac.org.ar/cvirtual/cvirteng/cienteng/mneng/mnm3007i/iberman/berman.htm. Accessed April 25, 2003. [Full Text].
Aggarwal A, Brown KA, LeWinter MM. Diastolic dysfunction: pathophysiology, clinical features, and assessment with radionuclide methods. J Nucl Cardiol. Jan-Feb 2001;8(1):98-106. [Medline].
Canty JM Jr, Fallavollita JA. Chronic hibernation and chronic stunning: a continuum. J Nucl Cardiol. Sep-Oct 2000;7(5):509-27. [Medline].
Eggers KM, Oldgren J, Nordenskjöld A, Lindahl B. Combining different biochemical markers of myocardial ischemia does not improve risk stratification in chest pain patients compared to troponin I alone. Coron Artery Dis. Aug 2005;16(5):315-9. [Medline].
Egred M, Waiter GD, Redpath TW, Semple SK, Al-Mohammad A, Walton S. Blood oxygen level-dependent (BOLD) MRI: A novel technique for the assessment of myocardial ischemia as identified by nuclear imaging SPECT. Eur J Intern Med. Dec 2007;18(8):581-6. [Medline].
Machecourt J, Longère P, Fagret D, Vanzetto G, Wolf JE, Polidori C, et al. Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect. Study in 1,926 patients with follow-up at 33 months. J Am Coll Cardiol. Apr 1994;23(5):1096-106. [Medline].
Sanz GA. [Risk stratification in acute coronary syndromes: an unresolved issue]. Rev Esp Cardiol. Oct 2007;60 Suppl 3:23-30. [Medline].
Further Reading
Keywords
angina pectoris, ischemic heart disease, atherosclerosis, atherosclerotic coronary heart disease, coronary artery disease, coronary arterial disease, CAD, coronary artery obstruction, heart attack, myocardial infarction, MI, acute myocardial infarction, AMI, nonanginal chest pain, atypical chest pain, typical chest pain, nuclear myocardial scanning
