Beyond traditional cardiovascular risk factors: Could frailty and other morbidities explain the worse prognosis in patie
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Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, VA Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
Received Nov 3, 2020; accepted Nov 3, 2020 doi:10.1007/s12350-020-02441-5
See related article, https://doi.org/10.10 07/s12350-020-02356-1.
Performance of exercise as the mode of stress in SPECT myocardial perfusion imaging studies brings enormous benefits! The exercise capacity in metabolic equivalents a patient is able to achieve during stress testing is the most powerful prognostic marker and predicts mortality and other cardiovascular events across multiple populations, including healthy individuals and in patients with cardiovascular disease irrespective of age, gender, and extent of coronary disease.1 Our lab has previously shown that the ability to achieve a high exercise workload of C10 METS identifies a group with a very low 0.4% prevalence of significant C10% left ventricular ischemia and a low prevalence of high-risk CAD on invasive coronary angiography.2,3 Moreover, those patients able to achieve C10 METS have an excellent prognosis over more than 2.5 years.4 Other studies have shown that lower functional capacity is associated with increased risk for myocardial infarction, unstable angina, and coronary revascularization.5 Functional capacity estimated using the Duke Activity
Funding This manuscript was supported by NIH T32 EB003841. Reprint requests: Jamieson M. Bourque, MD, MHS, Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, 1215 Lee Street, PO Box 800158Charlottesville, VA 22908; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Status Index (DASI) provides independent and incremental prognostic value for prediction of both significant coronary angiographic disease and long-term adverse clinical events.6 A number of additional parameters assessed by exercise stress provide powerful diagnostic and prognostic information additive to imaging results, including exercise ST segment deviation and rapidity of recovery post-stress,7,8 exercise-induced angina,9 blood pressure response to exercise,10 heart rate recovery,11 and chronotropic incompetence.12 The role of pharmacologic stress MPI in the risk stratification of patients is well-established, with excellent diagnostic accuracy.6,12 However, the wealth of incremental diagnostic and prognostic information provided with exercise stress mandates that this mode of stress should be strongly preferred and should be used whenever possible. Despite the clear benefits with exercise stress, the proportion of patients undergoing pharmacologic stress SPECT MPI has increased steadily over the past few decades relative to exercise imaging, from an initial third of patients to now more than 50% of stress imaging tests.13,14 This trend is hypothesized to be occurring due to the aging of the population and increasing preva
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