2010 Volume 74 Issue 8 Pages 1591-1599
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: Δend-systolic volume (ΔESV), Δenddiastolic volume (ΔEDV) and Δejection fraction (ΔEF). Myocardial stunning defined either as ΔESV ≥5 ml, ΔEDV ≥5 ml or ΔEF ≤5% was observed in 21%, 22%, or 26%, respectively. During a 3-year follow-up, 101 cardiac events occurred. Kaplan-Meier survival estimation indicated worse event-free survival rates in patients with dilated ESV, dilated EDV, LVEF ≤45%, ΔESV ≥5 ml or ΔEDV ≥5 ml than in those without, whereas ΔEF ≤5% did not predict events. Multivariate analysis demonstrated that LVEF ≤45% was the independent predictor for cardiac events. Nevertheless, ΔEDV ≥5 ml 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. (Circ J 2010; 74: 1591 - 1599)
