Prognostic value of post-ischemic stunning as assessed by gated myocardial perfusion single-photon emission computed tomography

Abstract

Background: To determine the prognostic value of post-ischemic stunning, the Japanese assessment of cardiac event and survival study by quantitative gated myocardial single-photon emission computed tomography (SPECT) (J-ACCESS) study was reevaluated.&Methods and Results: Of the 4,031 patients of the J-ACCESS, the present study evaluated 1,089 who completed gated SPECT both after stress and at rest. To assess post-ischemic stunning, the following measurements (left ventricular volumes after stress minus volumes at rest) were made: Aend-systolic volume (AESV), Aend-diastolic volume (AEDV) and Aejection fraction (AEF). Myocardial stunning defned either as AESV >5ml, AEDV >5ml or AEF <45%, AESV >5ml or AEDV >5ml than in those without, whereas AEF <45% was the independent predictor for cardiac events. Nevertheless, AEDV >5ml was also an independent parameter, in addition to LVEF <45%, to predict the combined endpoint of cardiac death, myocardial infarction, and revascularization, but excluding heart failure.&Conclusions: These results indicate that post-ischemic stunning, as assessed by gated SPECT, is a marker for poor prognosis, particularly for ischemic cardiac events.