Philippe Tellier MD, Presenter: Nothing to Disclose

Pascal Lecouffe, Abstract Co-Author: Nothing to Disclose

Mahmoud Zureik, Abstract Co-Author: Nothing to Disclose

Peripheral arterial occlusive disease (PAD) is a common disease associated with a high cardiovascular mortality and morbidity. Whole body exercise thallium scintigraphy can detect silent or symptomatic PAD. Whether perfusion asymmetry of legs induced by treadmill exercise and determined by thallium muscular scintigraphy has a prognostic value is unknown. The aim of this longitudinal study was to evaluate scintigraphic calf perfusion asymmetry at exercise as a prognostic factor.

358 consecutive patients (36 % of women, mean age =8.8±10.2 years, 56.4 % of previous coronary artery disease) with known or suspected coronary artery disease (CAD) who were referred to a nuclear mecidine department for exercise thallium 201 myocardial scintigraphy were included in this study and prospectively followed. Scintigraphic calf perfusion symmetry at exercise (SCPSE) was measured at the end of a treadmill exercise after intravenous injection of 75 to 92 MBq of thallium 201.Myocardial perfusion study was performed just before whole body thallium scintigraphy and myocardial ischemia was estimated by to experienced observers.

During the follow-up (mean 85.3±32.8 months), 93 cardiovascular events and cardiovascular deaths (incident cases) occurred. Among incident cases, the percentage of subjects with higher SCPSE values (third tertile) was 45.2 % compared to 29.1 % in controls (p=0.005). In the stepwise multivariate analysis performed by Cox model, previous CAD and SCPSE were the only significant independent predictors of prognosis. The multivariate relative risk of cardiovascular death or cardiovascular event in subjets with higher values of SCPSE was 1.94 (95 % CI 1.15 to 3.21, p<0.01).

This prospective study shows that scintigraphic calf perfusion asymmetry at exercise is independently associated with incident cardiovascular events in high risk subjects. If our results are confirmed, this index, which is easily and quickly performed, could be used as a new tool for identifying subjects with high cardiovascular risk.

Peripheral arterial occlusive disease (PAD) is a common disease associated with a high cardiovascular mortality and morbidity. Whole body exercise thallium scintigraphy can detect silent or symptomatic PAD. Whether perfusion asymmetry of legs induced by treadmill exercise and determined by thallium muscular scintigraphy has a prognostic value is unknown. The aim of this longitudinal study was to evaluate scintigraphic calf perfusion asymmetry at exercise as a prognostic factor.

358 consecutive patients (36 % of women, mean age =8.8±10.2 years, 56.4 % of previous coronary artery disease) with known or suspected coronary artery disease (CAD) who were referred to a nuclear mecidine department for exercise thallium 201 myocardial scintigraphy were included in this study and prospectively followed. Scintigraphic calf perfusion symmetry at exercise (SCPSE) was measured at the end of a treadmill exercise after intravenous injection of 75 to 92 MBq of thallium 201.Myocardial perfusion study was performed just before whole body thallium scintigraphy and myocardial ischemia was estimated by to experienced observers.

During the follow-up (mean 85.3±32.8 months), 93 cardiovascular events and cardiovascular deaths (incident cases) occurred. Among incident cases, the percentage of subjects with higher SCPSE values (third tertile) was 45.2 % compared to 29.1 % in controls (p=0.005). In the stepwise multivariate analysis performed by Cox model, previous CAD and SCPSE were the only significant independent predictors of prognosis. The multivariate relative risk of cardiovascular death or cardiovascular event in subjets with higher values of SCPSE was 1.94 (95 % CI 1.15 to 3.21, p<0.01).

This prospective study shows that scintigraphic calf perfusion asymmetry at exercise is independently associated with incident cardiovascular events in high risk subjects. If our results are confirmed, this index, which is easily and quickly performed, could be used as a new tool for identifying subjects with high cardiovascular risk.

Tellier, P, Lecouffe, P, Zureik, M, Scintigraphic Calf Perfusion Symmetry at Exercise: A New Non-invasive Index for Prediction of Cardiovascular Events in High-risk Subjects? Results of a Prospective Study.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407166.html