Worden Nicole E, Lindower Paul D, Burns Trudy L, Chatterjee Kanu, Weiss Robert M
Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA.
J Nucl Cardiol. 2015 Feb;22(1):115-22. doi: 10.1007/s12350-014-9934-0. Epub 2014 Jul 1.
Correction for soft tissue signal attenuation can improve the diagnostic accuracy of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). The aim of this study was to correlate SPECT-MPI findings with clinical outcomes in patients who underwent stress imaging in the supine position, who also underwent "second look" stress imaging in the prone position.
Patients without perfusion abnormalities were considered Normal (N = 270). Those with apparent supine stress perfusion abnormalities which all resolved during prone imaging formed the Normal-Prone group (N = 309). Patients with matched perfusion abnormalities during both supine and prone stress imaging were considered Abnormal (N = 169).
During follow-up (187 ± 96 days), utilization rates for invasive coronary angiography were similar for Normal vs Normal-Prone patients (3.5% vs 3.8%; P = NS), but were significantly higher in Abnormal patients (42.4%, P < .0001). Coronary revascularization occurred in 0.78%, 0.64%, and 17.7% of Normal, Normal-Prone, and Abnormal patients, respectively (P < .001). Cardiac death or myocardial infarction occurred in 2.2%, 2.3%, and 6.3% of Normal, Normal-Prone, and Abnormal patients, respectively (P = .02).
Second look SPECT-MPI identifies patients at low risk for death or myocardial infarction, who infrequently require invasive coronary angiography.
校正软组织信号衰减可提高单光子发射计算机断层扫描心肌灌注成像（SPECT-MPI）的诊断准确性。本研究的目的是将SPECT-MPI检查结果与仰卧位进行负荷成像且也进行俯卧位“二次检查”负荷成像的患者的临床结局相关联。
无灌注异常的患者被视为正常组（N = 270）。仰卧位负荷灌注有明显异常但在俯卧位成像时均消失的患者组成仰卧位-俯卧位正常组（N = 309）。仰卧位和俯卧位负荷成像时灌注异常相匹配的患者被视为异常组（N = 169）。
在随访期间（187±96天），正常组与仰卧位-俯卧位正常组患者进行有创冠状动脉造影的使用率相似（3.5%对3.8%；P =无显著性差异），但异常组患者的使用率显著更高（42.4%，P <.0001）。正常组、仰卧位-俯卧位正常组和异常组患者的冠状动脉血运重建发生率分别为0.78%、0.64%和17.7%（P <.001）。正常组、仰卧位-俯卧位正常组和异常组患者中心脏死亡或心肌梗死的发生率分别为2.2%、2.3%和6.3%（P =.02）。
二次检查SPECT-MPI可识别死亡或心肌梗死风险低且很少需要进行有创冠状动脉造影的患者。
