Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging

Leslee J. Shaw, Robert Hendel, Manuel Cerquiera, Jennifer H. Mieres, Naomi Alazraki, Elizabeth Krawczynska, Salvador Borges-Neto, Jamshid Maddahi, C. Noel Bairey Merz

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

OBJECTIVES: This study was designed to evaluate the differential prognostic value of gated single-photon emission computed tomographic imaging (SPECT) imaging in an ethnically diverse multicenter registry. BACKGROUND: Ethnic minority patient populations have reportedly higher coronary heart disease mortality with greater comorbidity and a clustering of risk factors at a significantly younger age when compared with Caucasian, non-Hispanic patients. Despite our increasingly diverse population, the predictive accuracy of cardiac imaging in ethnic minority patients is ill-defined. METHODS: A total of 7,849 patients were prospectively enrolled in a registry of patients undergoing exercise (44%) or pharmacologic stress (56%) technetium-99m tetrofosmin SPECT. Scans were scored using a 20-segment myocardial model with a 5-point severity index. Multivariable Cox proportional hazards models were employed to assess time to death or myocardial infarction. RESULTS: A total of 1,993 African-American, 464 Hispanic, and 5,258 Caucasian non-Hispanic patients underwent SPECT imaging. African-American and Hispanic patients more often had a history of stroke, peripheral arterial disease, angina, heart failure, diabetes, hypertension, and smoking at a younger age. Moderate or severely abnormal SPECT scans were noted in 21%, 17%, and 13% of African-American, Hispanic, and Caucasian non-Hispanic patients, respectively (p < 0.0001). Cardiovascular death rates were highest for ethnic minority patients (p < 0.0001). Annual rates of ischemic heart disease death ranged from 0.2% to 3.0% for Caucasian non-Hispanic and 0.8% to 6.5% for African-American patients with low-risk to severely abnormal SPECT scans (p < 0.0001). For post-stress ejection fraction <45%, annualized risk-adjusted death rates were 2.7% for Caucasian non-Hispanic patients versus 8.0% and 14.0% for African-American and Hispanic patients (p < 0.0001). CONCLUSIONS: The current results from a large observational registry reveal that exercise and pharmacologic stress SPECT effectively predicts major cardiovascular events in a large cohort of African-American and Hispanic patients evaluated for suspected myocardial ischemia. These results provide further evidence that ethnic minority patient populations have a worsening outcome related to cardiovascular disease.

Original languageEnglish
Pages (from-to)1494-1504
Number of pages11
JournalJournal of the American College of Cardiology
Volume45
Issue number9
DOIs
StatePublished - May 3 2005
Externally publishedYes

Fingerprint

Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Photons
African Americans
Hispanic Americans
Registries
technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane
Myocardial Ischemia
Mortality
Exercise
Population
Peripheral Arterial Disease
Proportional Hazards Models
Coronary Disease
Cluster Analysis
Comorbidity

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging. / Shaw, Leslee J.; Hendel, Robert; Cerquiera, Manuel; Mieres, Jennifer H.; Alazraki, Naomi; Krawczynska, Elizabeth; Borges-Neto, Salvador; Maddahi, Jamshid; Merz, C. Noel Bairey.

In: Journal of the American College of Cardiology, Vol. 45, No. 9, 03.05.2005, p. 1494-1504.

Research output: Contribution to journalArticle

Shaw, Leslee J. ; Hendel, Robert ; Cerquiera, Manuel ; Mieres, Jennifer H. ; Alazraki, Naomi ; Krawczynska, Elizabeth ; Borges-Neto, Salvador ; Maddahi, Jamshid ; Merz, C. Noel Bairey. / Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging. In: Journal of the American College of Cardiology. 2005 ; Vol. 45, No. 9. pp. 1494-1504.
@article{f1132b57cb9c4e8f8d97b8f9d73e52a8,
title = "Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging",
abstract = "OBJECTIVES: This study was designed to evaluate the differential prognostic value of gated single-photon emission computed tomographic imaging (SPECT) imaging in an ethnically diverse multicenter registry. BACKGROUND: Ethnic minority patient populations have reportedly higher coronary heart disease mortality with greater comorbidity and a clustering of risk factors at a significantly younger age when compared with Caucasian, non-Hispanic patients. Despite our increasingly diverse population, the predictive accuracy of cardiac imaging in ethnic minority patients is ill-defined. METHODS: A total of 7,849 patients were prospectively enrolled in a registry of patients undergoing exercise (44{\%}) or pharmacologic stress (56{\%}) technetium-99m tetrofosmin SPECT. Scans were scored using a 20-segment myocardial model with a 5-point severity index. Multivariable Cox proportional hazards models were employed to assess time to death or myocardial infarction. RESULTS: A total of 1,993 African-American, 464 Hispanic, and 5,258 Caucasian non-Hispanic patients underwent SPECT imaging. African-American and Hispanic patients more often had a history of stroke, peripheral arterial disease, angina, heart failure, diabetes, hypertension, and smoking at a younger age. Moderate or severely abnormal SPECT scans were noted in 21{\%}, 17{\%}, and 13{\%} of African-American, Hispanic, and Caucasian non-Hispanic patients, respectively (p < 0.0001). Cardiovascular death rates were highest for ethnic minority patients (p < 0.0001). Annual rates of ischemic heart disease death ranged from 0.2{\%} to 3.0{\%} for Caucasian non-Hispanic and 0.8{\%} to 6.5{\%} for African-American patients with low-risk to severely abnormal SPECT scans (p < 0.0001). For post-stress ejection fraction <45{\%}, annualized risk-adjusted death rates were 2.7{\%} for Caucasian non-Hispanic patients versus 8.0{\%} and 14.0{\%} for African-American and Hispanic patients (p < 0.0001). CONCLUSIONS: The current results from a large observational registry reveal that exercise and pharmacologic stress SPECT effectively predicts major cardiovascular events in a large cohort of African-American and Hispanic patients evaluated for suspected myocardial ischemia. These results provide further evidence that ethnic minority patient populations have a worsening outcome related to cardiovascular disease.",
author = "Shaw, {Leslee J.} and Robert Hendel and Manuel Cerquiera and Mieres, {Jennifer H.} and Naomi Alazraki and Elizabeth Krawczynska and Salvador Borges-Neto and Jamshid Maddahi and Merz, {C. Noel Bairey}",
year = "2005",
month = "5",
day = "3",
doi = "10.1016/j.jacc.2005.01.036",
language = "English",
volume = "45",
pages = "1494--1504",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "9",

}

TY - JOUR

T1 - Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated single-photon emission computed tomography myocardial perfusion imaging

AU - Shaw, Leslee J.

AU - Hendel, Robert

AU - Cerquiera, Manuel

AU - Mieres, Jennifer H.

AU - Alazraki, Naomi

AU - Krawczynska, Elizabeth

AU - Borges-Neto, Salvador

AU - Maddahi, Jamshid

AU - Merz, C. Noel Bairey

PY - 2005/5/3

Y1 - 2005/5/3

N2 - OBJECTIVES: This study was designed to evaluate the differential prognostic value of gated single-photon emission computed tomographic imaging (SPECT) imaging in an ethnically diverse multicenter registry. BACKGROUND: Ethnic minority patient populations have reportedly higher coronary heart disease mortality with greater comorbidity and a clustering of risk factors at a significantly younger age when compared with Caucasian, non-Hispanic patients. Despite our increasingly diverse population, the predictive accuracy of cardiac imaging in ethnic minority patients is ill-defined. METHODS: A total of 7,849 patients were prospectively enrolled in a registry of patients undergoing exercise (44%) or pharmacologic stress (56%) technetium-99m tetrofosmin SPECT. Scans were scored using a 20-segment myocardial model with a 5-point severity index. Multivariable Cox proportional hazards models were employed to assess time to death or myocardial infarction. RESULTS: A total of 1,993 African-American, 464 Hispanic, and 5,258 Caucasian non-Hispanic patients underwent SPECT imaging. African-American and Hispanic patients more often had a history of stroke, peripheral arterial disease, angina, heart failure, diabetes, hypertension, and smoking at a younger age. Moderate or severely abnormal SPECT scans were noted in 21%, 17%, and 13% of African-American, Hispanic, and Caucasian non-Hispanic patients, respectively (p < 0.0001). Cardiovascular death rates were highest for ethnic minority patients (p < 0.0001). Annual rates of ischemic heart disease death ranged from 0.2% to 3.0% for Caucasian non-Hispanic and 0.8% to 6.5% for African-American patients with low-risk to severely abnormal SPECT scans (p < 0.0001). For post-stress ejection fraction <45%, annualized risk-adjusted death rates were 2.7% for Caucasian non-Hispanic patients versus 8.0% and 14.0% for African-American and Hispanic patients (p < 0.0001). CONCLUSIONS: The current results from a large observational registry reveal that exercise and pharmacologic stress SPECT effectively predicts major cardiovascular events in a large cohort of African-American and Hispanic patients evaluated for suspected myocardial ischemia. These results provide further evidence that ethnic minority patient populations have a worsening outcome related to cardiovascular disease.

AB - OBJECTIVES: This study was designed to evaluate the differential prognostic value of gated single-photon emission computed tomographic imaging (SPECT) imaging in an ethnically diverse multicenter registry. BACKGROUND: Ethnic minority patient populations have reportedly higher coronary heart disease mortality with greater comorbidity and a clustering of risk factors at a significantly younger age when compared with Caucasian, non-Hispanic patients. Despite our increasingly diverse population, the predictive accuracy of cardiac imaging in ethnic minority patients is ill-defined. METHODS: A total of 7,849 patients were prospectively enrolled in a registry of patients undergoing exercise (44%) or pharmacologic stress (56%) technetium-99m tetrofosmin SPECT. Scans were scored using a 20-segment myocardial model with a 5-point severity index. Multivariable Cox proportional hazards models were employed to assess time to death or myocardial infarction. RESULTS: A total of 1,993 African-American, 464 Hispanic, and 5,258 Caucasian non-Hispanic patients underwent SPECT imaging. African-American and Hispanic patients more often had a history of stroke, peripheral arterial disease, angina, heart failure, diabetes, hypertension, and smoking at a younger age. Moderate or severely abnormal SPECT scans were noted in 21%, 17%, and 13% of African-American, Hispanic, and Caucasian non-Hispanic patients, respectively (p < 0.0001). Cardiovascular death rates were highest for ethnic minority patients (p < 0.0001). Annual rates of ischemic heart disease death ranged from 0.2% to 3.0% for Caucasian non-Hispanic and 0.8% to 6.5% for African-American patients with low-risk to severely abnormal SPECT scans (p < 0.0001). For post-stress ejection fraction <45%, annualized risk-adjusted death rates were 2.7% for Caucasian non-Hispanic patients versus 8.0% and 14.0% for African-American and Hispanic patients (p < 0.0001). CONCLUSIONS: The current results from a large observational registry reveal that exercise and pharmacologic stress SPECT effectively predicts major cardiovascular events in a large cohort of African-American and Hispanic patients evaluated for suspected myocardial ischemia. These results provide further evidence that ethnic minority patient populations have a worsening outcome related to cardiovascular disease.

UR - http://www.scopus.com/inward/record.url?scp=18144383024&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=18144383024&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2005.01.036

DO - 10.1016/j.jacc.2005.01.036

M3 - Article

C2 - 15862425

AN - SCOPUS:18144383024

VL - 45

SP - 1494

EP - 1504

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 9

ER -