Prospective evaluation of a new protocol for the provisional use of perfusion imaging with exercise stress testing.

Purpose: Previous literature suggests that myocardial perfusion imaging (MPI) adds little to the prognosis of patients who exercise >10 metabolic equivalents (METs) during stress testing. With this in mind, we prospectively tested a provisional injection protocol in emergency department (ED) patients presenting for the evaluation of chest pain in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response.

Methods: All patients who presented to the ED over a 5-year period who were referred for stress testing as part of their ED evaluation were included.

A comparison of coronary CTA and stress testing using high-efficiency SPECT MPI for the evaluation of chest pain in the emergency department.

Background: Recent studies have compared CTA to stress testing and MPI using older Na-I SPECT cameras and traditional rest-stress protocols, but are limited by often using optimized CTA protocols but suboptimal MPI methodology. We compared CTA to stress testing with modern SPECT MPI using high-efficiency CZT cameras and stress-first protocols in an ED population.

Methods: In a retrospective, non-randomized study, all patients who underwent CTA or stress testing (ETT or Tc-99m sestamibi SPECT MPI) as part of their ED assessment in 2010-2011 driven by ED attending preference and equipment availability were evaluated for their disposition from the ED (admission vs discharge, length of time to disposition), subsequent visits to the ED and diagnostic testing (within 3 months), and radiation exposure.

A hypothetical protocol for the provisional use of perfusion imaging with exercise stress testing.

Background: Previous literature suggests that the results of myocardial perfusion imaging (MPI) add little to the prognosis of patients who exercise >10 metabolic equivalents (METS) during stress testing. With this in mind, we attempted to determine if a provisional injection protocol could be developed in which a patient would not receive an injection of radioisotope if adequate exercise was achieved without symptoms and a negative ECG response. This protocol would save a substantial amount of time, radiation exposure, and cost.

A model for the prediction of a successful stress-first Tc-99m SPECT MPI.

Background: Stress-only Tc-99m MPI saves time, radiation exposure, and a normal study has a benign prognosis. However, a stress-first protocol is relatively labor intensive requiring pre-test screening for suitability and early post-stress image review to determine the need for rest imaging. The purpose of this study was to develop a simple clinical score used prior to a patient's myocardial perfusion imaging (MPI) study to determine if they should undergo a stress-first protocol.

The prognosis of a normal Tl-201 stress-only SPECT MPI study.

Background: Stress-only Tc-99m SPECT myocardial perfusion imaging (MPI) decreases test time and patient radiation exposure with a proven benign prognosis of a normal study. The imaging sequence of Tl-201 MPI always starts with the stress portion; therefore, no pre-test decisions are needed regarding the imaging sequence. The recent intermittent Tc-99m shortage afforded the unique opportunity to study an unselected group of patients undergoing Tl-201 imaging.