Author + information
- Received February 16, 2006
- Revision received August 23, 2006
- Accepted August 28, 2006
- Published online January 16, 2007.
- Louise D. Metz, MD⁎,
- Mary Beattie, MD†,
- Robert Hom, MD‡,
- Rita F. Redberg, MD, MSc§,
- Deborah Grady, MD, MPH∥,¶,† and
- Kirsten E. Fleischmann, MD, MPH§,1,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Kirsten Fleischmann, University of California, San Francisco, Box 0124, M M1177, San Francisco, California 94143.
Objectives The purpose of this work was to determine the prognostic value of normal exercise myocardial perfusion imaging (MPI) tests and exercise echocardiography tests, and to determine the prognostic value of these imaging modalities in women and men.
Background Exercise MPI and exercise echocardiography provide prognostic information that is useful in the risk stratification of patients with suspected coronary artery disease (CAD).
Methods We searched the PubMed, Cochrane, and DARE databases between January 1990 and May 2005, and reviewed bibliographies of articles obtained. We included prospective cohort studies of subjects who underwent exercise MPI or exercise echocardiography for known or suspected CAD, and provided data on primary outcomes of myocardial infarction (MI) and cardiac death with at least 3 months of follow-up. Secondary outcomes (unstable angina, revascularization procedures) were abstracted if provided. Studies performed exclusively in patients with CAD were excluded.
Results The negative predictive value (NPV) for MI and cardiac death was 98.8% (95% confidence interval [CI] 98.5 to 99.0) over 36 months of follow-up for MPI, and 98.4% (95% CI 97.9 to 98.9) over 33 months for echocardiography. The corresponding annualized event rates were 0.45% per year for MPI and 0.54% per year for echocardiography. In subgroup analyses, annualized event rates were <1% for each MPI isotope, and were similar for women and men. For secondary events, MPI and echocardiography had annualized event rates of 1.25% and 0.95%, respectively.
Conclusions Both exercise MPI and exercise echocardiography have high NPVs for primary and secondary cardiac events. The prognostic utility of both modalities is similar for both men and women.
↵1 Dr. Fleischmann was supported by an Outcomes Research Award from the American Society of Echocardiography.
This work was performed, in part, by the University of California, San Francisco-Stanford Evidence-Based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0013), the Women’s Health Clinical Research Center at the University of California, San Francisco, and was supported in part by the U.S. Department of Veterans Affairs.
- Received February 16, 2006.
- Revision received August 23, 2006.
- Accepted August 28, 2006.
- American College of Cardiology Foundation