Relation between ambulatory electrocardiographic monitoring and myocardial perfusion imaging to detect coronary artery disease and myocardial ischemia: An ACIP ancillary study

John J. Mahmarian, Richard M. Steingart, Sandra Forman, Barry L. Sharaf, Mary Ellen Coglianese, Donald D Miller, Carl J. Pepine, A. David Goldberg, Marilyn F. Bloom, Sheila Byers, Laurel Dvorak, Craig M. Pratt

Research output: Contribution to journalArticle

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Abstract

Objectives. This study sought to explore the relation between markers of ischemia detected by ambulatory electrocardiographic (AECG) monitoring and stress myocardial perfusion single-photon emission computed tomography (SPECT). Background. Stress myocardial SPECT and AECG monitoring are both utilized in evaluating patients with coronary artery disease. However, information is limited regarding the relation between the presence and extent of ischemia as detected by these two modalities. Methods. This was an ancillary study of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial. One hundred six patients with previous coronary angiography underwent AECG monitoring and stress SPECT within a close temporal time period. The frequency and duration of ischemia as assessed by AECG monitoring and the total and ischemic stress-induced myocardial perfusion defect sizes as assessed by SPECT were quantified in separate core laboratories. Multivariate logistic regression and linear regression analysis were used to determine associations between AECG and SPECT abnormalities with regard to angiographic, demographic and treadmill exercise variables. Results. Seventy-four percent of patients with significant (≤50%) coronary artery stenosis had SPECT abnormalities, whereas 61% had ischemia by AECG monitoring. The most important predictors of SPECT abnormalities were severity (p < 0.001) of coronary artery stenosis, followed by total exercise duration (p = 0.016) and patient age (p = 0.04). The only predictor of AECG abnormalities was the presence of ST segment depression on the initial exercise treadmill test (p = 0.021). Only a 50% concordance for normalcy or abnormalcy was observed between the SPECT and AECG results, and no relation was observed between the frequency or duration of AECG ischemia and the quantified total or ischemic myocardial perfusion defect size as assessed by SPECT. Conclusions. Ischemia as detected by AECG monitoring does not correlate with the presence and extent of ischemia as quantified by stress SPECT. Because these techniques appear to detect different pathophysiologic manifestations of ischemia, they may be complementary in more fully defining the functional significance of coronary artery disease and, in particular, which patients are at highest risk for adverse cardiac events.

Original languageEnglish (US)
Pages (from-to)764-769
Number of pages6
JournalJournal of the American College of Cardiology
Volume29
Issue number4
DOIs
StatePublished - Mar 15 1997

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Ambulatory Electrocardiography
Myocardial Perfusion Imaging
Single-Photon Emission-Computed Tomography
Myocardial Ischemia
Coronary Artery Disease
Ischemia
Perfusion
Coronary Stenosis
Exercise Test
Exercise
Coronary Angiography
Linear Models
Logistic Models
Regression Analysis
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation between ambulatory electrocardiographic monitoring and myocardial perfusion imaging to detect coronary artery disease and myocardial ischemia : An ACIP ancillary study. / Mahmarian, John J.; Steingart, Richard M.; Forman, Sandra; Sharaf, Barry L.; Coglianese, Mary Ellen; Miller, Donald D; Pepine, Carl J.; Goldberg, A. David; Bloom, Marilyn F.; Byers, Sheila; Dvorak, Laurel; Pratt, Craig M.

In: Journal of the American College of Cardiology, Vol. 29, No. 4, 15.03.1997, p. 764-769.

Research output: Contribution to journalArticle

Mahmarian, John J. ; Steingart, Richard M. ; Forman, Sandra ; Sharaf, Barry L. ; Coglianese, Mary Ellen ; Miller, Donald D ; Pepine, Carl J. ; Goldberg, A. David ; Bloom, Marilyn F. ; Byers, Sheila ; Dvorak, Laurel ; Pratt, Craig M. / Relation between ambulatory electrocardiographic monitoring and myocardial perfusion imaging to detect coronary artery disease and myocardial ischemia : An ACIP ancillary study. In: Journal of the American College of Cardiology. 1997 ; Vol. 29, No. 4. pp. 764-769.
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abstract = "Objectives. This study sought to explore the relation between markers of ischemia detected by ambulatory electrocardiographic (AECG) monitoring and stress myocardial perfusion single-photon emission computed tomography (SPECT). Background. Stress myocardial SPECT and AECG monitoring are both utilized in evaluating patients with coronary artery disease. However, information is limited regarding the relation between the presence and extent of ischemia as detected by these two modalities. Methods. This was an ancillary study of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial. One hundred six patients with previous coronary angiography underwent AECG monitoring and stress SPECT within a close temporal time period. The frequency and duration of ischemia as assessed by AECG monitoring and the total and ischemic stress-induced myocardial perfusion defect sizes as assessed by SPECT were quantified in separate core laboratories. Multivariate logistic regression and linear regression analysis were used to determine associations between AECG and SPECT abnormalities with regard to angiographic, demographic and treadmill exercise variables. Results. Seventy-four percent of patients with significant (≤50{\%}) coronary artery stenosis had SPECT abnormalities, whereas 61{\%} had ischemia by AECG monitoring. The most important predictors of SPECT abnormalities were severity (p < 0.001) of coronary artery stenosis, followed by total exercise duration (p = 0.016) and patient age (p = 0.04). The only predictor of AECG abnormalities was the presence of ST segment depression on the initial exercise treadmill test (p = 0.021). Only a 50{\%} concordance for normalcy or abnormalcy was observed between the SPECT and AECG results, and no relation was observed between the frequency or duration of AECG ischemia and the quantified total or ischemic myocardial perfusion defect size as assessed by SPECT. Conclusions. Ischemia as detected by AECG monitoring does not correlate with the presence and extent of ischemia as quantified by stress SPECT. Because these techniques appear to detect different pathophysiologic manifestations of ischemia, they may be complementary in more fully defining the functional significance of coronary artery disease and, in particular, which patients are at highest risk for adverse cardiac events.",
author = "Mahmarian, {John J.} and Steingart, {Richard M.} and Sandra Forman and Sharaf, {Barry L.} and Coglianese, {Mary Ellen} and Miller, {Donald D} and Pepine, {Carl J.} and Goldberg, {A. David} and Bloom, {Marilyn F.} and Sheila Byers and Laurel Dvorak and Pratt, {Craig M.}",
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T1 - Relation between ambulatory electrocardiographic monitoring and myocardial perfusion imaging to detect coronary artery disease and myocardial ischemia

T2 - An ACIP ancillary study

AU - Mahmarian, John J.

AU - Steingart, Richard M.

AU - Forman, Sandra

AU - Sharaf, Barry L.

AU - Coglianese, Mary Ellen

AU - Miller, Donald D

AU - Pepine, Carl J.

AU - Goldberg, A. David

AU - Bloom, Marilyn F.

AU - Byers, Sheila

AU - Dvorak, Laurel

AU - Pratt, Craig M.

PY - 1997/3/15

Y1 - 1997/3/15

N2 - Objectives. This study sought to explore the relation between markers of ischemia detected by ambulatory electrocardiographic (AECG) monitoring and stress myocardial perfusion single-photon emission computed tomography (SPECT). Background. Stress myocardial SPECT and AECG monitoring are both utilized in evaluating patients with coronary artery disease. However, information is limited regarding the relation between the presence and extent of ischemia as detected by these two modalities. Methods. This was an ancillary study of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial. One hundred six patients with previous coronary angiography underwent AECG monitoring and stress SPECT within a close temporal time period. The frequency and duration of ischemia as assessed by AECG monitoring and the total and ischemic stress-induced myocardial perfusion defect sizes as assessed by SPECT were quantified in separate core laboratories. Multivariate logistic regression and linear regression analysis were used to determine associations between AECG and SPECT abnormalities with regard to angiographic, demographic and treadmill exercise variables. Results. Seventy-four percent of patients with significant (≤50%) coronary artery stenosis had SPECT abnormalities, whereas 61% had ischemia by AECG monitoring. The most important predictors of SPECT abnormalities were severity (p < 0.001) of coronary artery stenosis, followed by total exercise duration (p = 0.016) and patient age (p = 0.04). The only predictor of AECG abnormalities was the presence of ST segment depression on the initial exercise treadmill test (p = 0.021). Only a 50% concordance for normalcy or abnormalcy was observed between the SPECT and AECG results, and no relation was observed between the frequency or duration of AECG ischemia and the quantified total or ischemic myocardial perfusion defect size as assessed by SPECT. Conclusions. Ischemia as detected by AECG monitoring does not correlate with the presence and extent of ischemia as quantified by stress SPECT. Because these techniques appear to detect different pathophysiologic manifestations of ischemia, they may be complementary in more fully defining the functional significance of coronary artery disease and, in particular, which patients are at highest risk for adverse cardiac events.

AB - Objectives. This study sought to explore the relation between markers of ischemia detected by ambulatory electrocardiographic (AECG) monitoring and stress myocardial perfusion single-photon emission computed tomography (SPECT). Background. Stress myocardial SPECT and AECG monitoring are both utilized in evaluating patients with coronary artery disease. However, information is limited regarding the relation between the presence and extent of ischemia as detected by these two modalities. Methods. This was an ancillary study of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial. One hundred six patients with previous coronary angiography underwent AECG monitoring and stress SPECT within a close temporal time period. The frequency and duration of ischemia as assessed by AECG monitoring and the total and ischemic stress-induced myocardial perfusion defect sizes as assessed by SPECT were quantified in separate core laboratories. Multivariate logistic regression and linear regression analysis were used to determine associations between AECG and SPECT abnormalities with regard to angiographic, demographic and treadmill exercise variables. Results. Seventy-four percent of patients with significant (≤50%) coronary artery stenosis had SPECT abnormalities, whereas 61% had ischemia by AECG monitoring. The most important predictors of SPECT abnormalities were severity (p < 0.001) of coronary artery stenosis, followed by total exercise duration (p = 0.016) and patient age (p = 0.04). The only predictor of AECG abnormalities was the presence of ST segment depression on the initial exercise treadmill test (p = 0.021). Only a 50% concordance for normalcy or abnormalcy was observed between the SPECT and AECG results, and no relation was observed between the frequency or duration of AECG ischemia and the quantified total or ischemic myocardial perfusion defect size as assessed by SPECT. Conclusions. Ischemia as detected by AECG monitoring does not correlate with the presence and extent of ischemia as quantified by stress SPECT. Because these techniques appear to detect different pathophysiologic manifestations of ischemia, they may be complementary in more fully defining the functional significance of coronary artery disease and, in particular, which patients are at highest risk for adverse cardiac events.

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