Prevalence and predictors of automatically quantified myocardial ischemia within a multicenter international registry

J Nucl Cardiol. 2022 Dec;29(6):3221-3232. doi: 10.1007/s12350-021-02829-x. Epub 2022 Feb 16.

Abstract

Background: The utility of cardiac stress testing depends on the prevalence of myocardial ischemia within candidate populations. However, a comprehensive assessment of the factors influencing frequency of myocardial ischemia within contemporary populations referred for stress testing has not been performed.

Methods: We assessed 19,690 patients undergoing nuclear stress testing from a multicenter registry. The chi-square test was used to assess the relative importance of features for predicting myocardial ischemia.

Results: In the overall cohort, LVEF, male gender, and rest total perfusion deficit (TPD) were the top three predictors of ischemia, followed by CAD status, age, typical angina, and CAD risk factors. Myocardial ischemia was observed in 13.6 % of patients with LVEF > 55 %, in 26.2 % of patients with LVEF 45 %-54 %, and in 48.3% among patients with LVEF < 45 % (P < 0.001). A similar pattern was noted for rest TPD (P < 0.001). Men had a threefold higher frequency of ischemia versus women (25.8 % vs. 8.4%, P < 0.001). Although the relative ranking of ischemia predictors varied among centers, LVEF and/or rest TPD were among the two most potent predictors of myocardial ischemia within each center.

Conclusion: The prevalence of myocardial ischemia varied markedly according to clinical and imaging characteristics. LVEF and rest TPD are robust predictors of myocardial ischemia.

Keywords: Cardiac stress testing; Coronary artery disease; Myocardial ischemia; Myocardial perfusion imaging.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / epidemiology
  • Female
  • Humans
  • Male
  • Myocardial Ischemia* / diagnostic imaging
  • Myocardial Ischemia* / epidemiology
  • Myocardial Perfusion Imaging* / methods
  • Prevalence
  • Registries
  • Tomography, Emission-Computed, Single-Photon