TY - JOUR
T1 - Serial myocardial perfusion imaging
T2 - Defining a significant change and targeting management decisions
AU - Iskandrian, Ami E.
AU - Hage, Fadi G.
AU - Shaw, Leslee J.
AU - Mahmarian, John J.
AU - Berman, Daniel S.
N1 - Funding Information:
Dr. Iskandrian has received research grants from Astellas Pharma US and GE Healthcare ; and has been a consultant to RapidScan, Inc., Astellas Pharma US, and Gilead. Dr. Hage has received a research grant from Astellas Pharma US. Dr. Shaw has received research grant support from Astellas Pharma US and Bracco Diagnostics . Dr. Mahmarian has been a consultant for Astellas Pharma US; and has been on the Speakers' Bureau of Astellas Pharma US. Dr. Berman has received grants from Lantheus, Astellas, Cardium Therapeutics, and GE; has served on the advisory board for Astellas, GE, and Spectrum-Dynamics; has received royalties from Cedars-Sinai Medical Center (software); and holds equity in Spectrum Dynamics.
PY - 2014/1
Y1 - 2014/1
N2 - Myocardial perfusion imaging (MPI) with gated single-photon emission tomography provides important information on the extent and severity of myocardial perfusion abnormalities, including myocardial ischemia. The availability of software for automated quantitative assessment of myocardial perfusion in an objective and more reproducible manner than visual assessment has allowed MPI to be particularly effective in serial evaluation. Serial testing using MPI is widely used in guiding patient care despite the lack of well-defined appropriateness use criteria. This should not be surprising because ischemic heart disease is a life-long malady subject to dynamic changes throughout its natural course and particularly following man-made interventions that may improve or worsen the disease process, such as medical therapy and coronary revascularization. Serial MPI has filled an important clinical gap by providing crucial information for managing patients with changes in clinical presentations or in anticipation of such changes in patients with stable symptoms. In the research arena, serial MPI has been widely applied in randomized controlled trials to study the impact of various medical and interventional therapies on myocardial perfusion, as well as the relative merits of new imaging procedures (hardware and/or software), radiotracers, and stressor agents. Serial testing, however, unlike initial or 1-time testing, has more stringent requirements and is subject to variability because of technical, procedural, interpretational, and biological factors. The intrinsic variability of MPI becomes important in interpreting serial tests in order to define a true change in a given patient and to guide clinical decision making. The purpose of this first comprehensive review on this subject is to illustrate where serial MPI may be useful clinically and in research studies, and to highlight strategies for addressing the various issues that are unique to serial testing in order to derive more valid and robust data from the serial scans.
AB - Myocardial perfusion imaging (MPI) with gated single-photon emission tomography provides important information on the extent and severity of myocardial perfusion abnormalities, including myocardial ischemia. The availability of software for automated quantitative assessment of myocardial perfusion in an objective and more reproducible manner than visual assessment has allowed MPI to be particularly effective in serial evaluation. Serial testing using MPI is widely used in guiding patient care despite the lack of well-defined appropriateness use criteria. This should not be surprising because ischemic heart disease is a life-long malady subject to dynamic changes throughout its natural course and particularly following man-made interventions that may improve or worsen the disease process, such as medical therapy and coronary revascularization. Serial MPI has filled an important clinical gap by providing crucial information for managing patients with changes in clinical presentations or in anticipation of such changes in patients with stable symptoms. In the research arena, serial MPI has been widely applied in randomized controlled trials to study the impact of various medical and interventional therapies on myocardial perfusion, as well as the relative merits of new imaging procedures (hardware and/or software), radiotracers, and stressor agents. Serial testing, however, unlike initial or 1-time testing, has more stringent requirements and is subject to variability because of technical, procedural, interpretational, and biological factors. The intrinsic variability of MPI becomes important in interpreting serial tests in order to define a true change in a given patient and to guide clinical decision making. The purpose of this first comprehensive review on this subject is to illustrate where serial MPI may be useful clinically and in research studies, and to highlight strategies for addressing the various issues that are unique to serial testing in order to derive more valid and robust data from the serial scans.
KW - coronary artery disease
KW - myocardial ischemia
KW - myocardial perfusion imaging
KW - single-photon emission tomography
KW - stress testing
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U2 - 10.1016/j.jcmg.2013.05.022
DO - 10.1016/j.jcmg.2013.05.022
M3 - Review article
C2 - 24433711
AN - SCOPUS:84892542017
SN - 1936-878X
VL - 7
SP - 79
EP - 96
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 1
ER -