Advanced technology in the risk stratification-based strategy: The way forward to keep going
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Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
Received May 8, 2020; accepted May 8, 2020 doi:10.1007/s12350-020-02198-x
See related article, https://doi.org/10.10 07/s12350-020-02128-x
Myocardial perfusion imaging (MPI) represents the most common used noninvasive diagnostic procedure in patients with suspected or known coronary artery disease (CAD). Many studies in literature have been published over the years demonstrating the high accuracy of the nuclear cardiology procedures in the diagnosis of CAD.1 Nowadays, the greatest clinical impact of such procedures is linked to their prognostic value.2 In particular, in the latest years clinical research is oriented on demonstrate effectiveness of MPI for an appropriate use in imaging guided strategy in patients with suspected or known CAD.3 In this context, risk assessment represents an important step to identify patients at high risk of disease requiring a specific diagnostic and/or therapeutic approach to prevent adverse events at short and long-term follow-up. The risk of developing cardiovascular disease is influenced by the combined effects of several factors, which can have higher predictive values when combined in predictive models. In this context, gated single-photon emission computed tomography (SPECT) MPI provides important prognostic information related to both the extent and severity of myocardial perfusion abnormalities and dysfunctional left ventricular (LV) parameters.2–4 Moreover, it is widely demonstrated that there was a linear relationship between the extent of
Reprint requests: Wanda Acampa, MD, PhD, Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
such abnormalities and cardiac event rate.5 Moreover, a normal MPI was associated with a very low risk of cardiac events, less than 1% in the rate of adverse events, with 5 to 6-fold increase in the presence of abnormal SPECT MPI.6 In terms of guided strategy, several reports have examined differences in clinical outcomes for referring patients according to MPI results to coronary revascularization or medical therapy alone.7–9 These results suggest that there may be a threshold whereby patients with moderate to severe ischemia may benefit in terms of reduced mortality and CAD events when a revascularization strategy is applied vs as compared with medical therapy alone.7 In addition, important findings outlined that patients undergoing to percutaneous coronary intervention plus medical therapy showed a greater reduction in ischemia with associate lower risk of cardiovascular events as compared to those treated with only medical therapy.10 Moreover, in patients with stable disease it has been demonstrated that worsening of myocardial ischemia more than 5% represent an independent predictor of cardiac events.9 All these studi
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