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Background <p>Exercise parameters achieved during an exercise stress myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) study may help to predict clinical outcomes. The aim of our study was to compare different exercise stress parameters to determine their prognostic utility following a normal rest- exercise stress MPI.</p> Methods <p>We performed a retrospective cohort study on 3290 consecutive patients who had undergone rest-exercise-stress MPI from 2017 to 2024. 1020 patients had normal perfusion images and were included in the analysis. The primary endpoint of the study was a composite of all-cause mortality, non-fatal myocardial infarction and coronary revascularization. Using multivariable survival analysis, we evaluated the incremental prognostic risks of exercise and clinical factors to predict the primary end point.</p> Results <p>58% of the cohort were male, the mean age was 59 ± 10 years. During a follow-up of 55 ± 22 months, 44 primary events occurred. On univariable and multivariable survival analysis achieving &lt; 85% of the maximum age predicted heart rate (APHR<sub>max</sub>) was not associated with an increase in risk. In patients who achieved a maximal heart rate and stress systolic blood pressure product (rate pressure product, RPP<sub>stress</sub>) of &lt; 25,000, the risk of the primary end point was increased (HR 2.03 (1.08–3.83), <i>p</i> = 0.028).</p> Conclusions <p>RPP<sub>stress</sub> and not APHR<sub>max</sub> had incremental prognostic risk following normal rest-exercise-stress MPI SPECT. RPP<sub>stress</sub> might be considered as an additional parameter to be included in SPECT-MPI reporting to assist clinicians in risk stratification.</p>

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Utility of stress parameters to determine prognosis following normal exercise SPECT myocardial perfusion imaging

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月18日

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  • Zeinab Shirazi,
  • Zohreh Adinehpour,
  • Toby David Small,
  • R. Glenn Wells,
  • Kevin E. Boczar,
  • Benjamin J. W. Chow,
  • Gary R. Small

摘要

Background

Exercise parameters achieved during an exercise stress myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) study may help to predict clinical outcomes. The aim of our study was to compare different exercise stress parameters to determine their prognostic utility following a normal rest- exercise stress MPI.

Methods

We performed a retrospective cohort study on 3290 consecutive patients who had undergone rest-exercise-stress MPI from 2017 to 2024. 1020 patients had normal perfusion images and were included in the analysis. The primary endpoint of the study was a composite of all-cause mortality, non-fatal myocardial infarction and coronary revascularization. Using multivariable survival analysis, we evaluated the incremental prognostic risks of exercise and clinical factors to predict the primary end point.

Results

58% of the cohort were male, the mean age was 59 ± 10 years. During a follow-up of 55 ± 22 months, 44 primary events occurred. On univariable and multivariable survival analysis achieving < 85% of the maximum age predicted heart rate (APHRmax) was not associated with an increase in risk. In patients who achieved a maximal heart rate and stress systolic blood pressure product (rate pressure product, RPPstress) of < 25,000, the risk of the primary end point was increased (HR 2.03 (1.08–3.83), p = 0.028).

Conclusions

RPPstress and not APHRmax had incremental prognostic risk following normal rest-exercise-stress MPI SPECT. RPPstress might be considered as an additional parameter to be included in SPECT-MPI reporting to assist clinicians in risk stratification.