The Value of Myocardial Perfusion Single-Photon Emission Computed Tomography in Screening Asymptomatic Patients With Atrial Fibrillation for Coronary Artery Disease

J. Wells Askew, Todd D. Miller, David O. Hodge, Raymond J Gibbons

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives: We sought to determine if screening for coronary artery disease (CAD) with stress single-photon emission computed tomography (SPECT) is of value in patients with atrial fibrillation (AF) who do not have symptoms of chest pain or dyspnea. Background: Although noninvasive stress testing is often done to screen for CAD in asymptomatic patients with AF and is considered to be appropriate in selected patients, its potential utility has not been demonstrated. Methods: A retrospective study was conducted of 374 asymptomatic patients with AF referred for the detection of CAD. Mean follow-up was 5.7 ± 3.8 years. The study group was compared with a control group of 374 asymptomatic age and gender-matched patients without AF. Results: The mean summed stress score (SSS) was not significantly different between AF patients and control subjects (3.6 ± 5.3 vs. 3.5 ± 5.9; p = 0.35). Compared with controls, asymptomatic AF patients had similar rates of abnormal SPECT studies (51.6% vs. 48.4%; p = 0.38) and high-risk studies (14.4% vs. 14.4%; p = 1.0). The SSS was a significant predictor of outcome in both AF patients and control subjects. However, total mortality was significantly greater in AF patients (5-year overall mortality 27% vs. 18%, 10-year overall mortality 47% vs. 40%; p < 0.001), and this difference persisted (p = 0.01) after adjusting for multiple clinical variables and the SSS. Conclusions: Screening for CAD using stress SPECT in asymptomatic AF patients has a yield similar to age- and gender-matched control patients without AF. Although SSS predicts mortality in patients with and without AF, patients with AF have increased total mortality independent of the findings on stress SPECT. These results suggest that factors other than obstructive CAD are responsible for the increased mortality in AF.

Original languageEnglish (US)
Pages (from-to)1080-1085
Number of pages6
JournalJournal of the American College of Cardiology
Volume50
Issue number11
DOIs
StatePublished - Sep 11 2007

Fingerprint

Single-Photon Emission-Computed Tomography
Atrial Fibrillation
Coronary Artery Disease
Perfusion
Mortality
Chest Pain
Dyspnea
Retrospective Studies

ASJC Scopus subject areas

  • Nursing(all)

Cite this

The Value of Myocardial Perfusion Single-Photon Emission Computed Tomography in Screening Asymptomatic Patients With Atrial Fibrillation for Coronary Artery Disease. / Askew, J. Wells; Miller, Todd D.; Hodge, David O.; Gibbons, Raymond J.

In: Journal of the American College of Cardiology, Vol. 50, No. 11, 11.09.2007, p. 1080-1085.

Research output: Contribution to journalArticle

@article{6bf369c6770141fd8a63c71f70cf7209,
title = "The Value of Myocardial Perfusion Single-Photon Emission Computed Tomography in Screening Asymptomatic Patients With Atrial Fibrillation for Coronary Artery Disease",
abstract = "Objectives: We sought to determine if screening for coronary artery disease (CAD) with stress single-photon emission computed tomography (SPECT) is of value in patients with atrial fibrillation (AF) who do not have symptoms of chest pain or dyspnea. Background: Although noninvasive stress testing is often done to screen for CAD in asymptomatic patients with AF and is considered to be appropriate in selected patients, its potential utility has not been demonstrated. Methods: A retrospective study was conducted of 374 asymptomatic patients with AF referred for the detection of CAD. Mean follow-up was 5.7 ± 3.8 years. The study group was compared with a control group of 374 asymptomatic age and gender-matched patients without AF. Results: The mean summed stress score (SSS) was not significantly different between AF patients and control subjects (3.6 ± 5.3 vs. 3.5 ± 5.9; p = 0.35). Compared with controls, asymptomatic AF patients had similar rates of abnormal SPECT studies (51.6{\%} vs. 48.4{\%}; p = 0.38) and high-risk studies (14.4{\%} vs. 14.4{\%}; p = 1.0). The SSS was a significant predictor of outcome in both AF patients and control subjects. However, total mortality was significantly greater in AF patients (5-year overall mortality 27{\%} vs. 18{\%}, 10-year overall mortality 47{\%} vs. 40{\%}; p < 0.001), and this difference persisted (p = 0.01) after adjusting for multiple clinical variables and the SSS. Conclusions: Screening for CAD using stress SPECT in asymptomatic AF patients has a yield similar to age- and gender-matched control patients without AF. Although SSS predicts mortality in patients with and without AF, patients with AF have increased total mortality independent of the findings on stress SPECT. These results suggest that factors other than obstructive CAD are responsible for the increased mortality in AF.",
author = "Askew, {J. Wells} and Miller, {Todd D.} and Hodge, {David O.} and Gibbons, {Raymond J}",
year = "2007",
month = "9",
day = "11",
doi = "10.1016/j.jacc.2007.05.035",
language = "English (US)",
volume = "50",
pages = "1080--1085",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "11",

}

TY - JOUR

T1 - The Value of Myocardial Perfusion Single-Photon Emission Computed Tomography in Screening Asymptomatic Patients With Atrial Fibrillation for Coronary Artery Disease

AU - Askew, J. Wells

AU - Miller, Todd D.

AU - Hodge, David O.

AU - Gibbons, Raymond J

PY - 2007/9/11

Y1 - 2007/9/11

N2 - Objectives: We sought to determine if screening for coronary artery disease (CAD) with stress single-photon emission computed tomography (SPECT) is of value in patients with atrial fibrillation (AF) who do not have symptoms of chest pain or dyspnea. Background: Although noninvasive stress testing is often done to screen for CAD in asymptomatic patients with AF and is considered to be appropriate in selected patients, its potential utility has not been demonstrated. Methods: A retrospective study was conducted of 374 asymptomatic patients with AF referred for the detection of CAD. Mean follow-up was 5.7 ± 3.8 years. The study group was compared with a control group of 374 asymptomatic age and gender-matched patients without AF. Results: The mean summed stress score (SSS) was not significantly different between AF patients and control subjects (3.6 ± 5.3 vs. 3.5 ± 5.9; p = 0.35). Compared with controls, asymptomatic AF patients had similar rates of abnormal SPECT studies (51.6% vs. 48.4%; p = 0.38) and high-risk studies (14.4% vs. 14.4%; p = 1.0). The SSS was a significant predictor of outcome in both AF patients and control subjects. However, total mortality was significantly greater in AF patients (5-year overall mortality 27% vs. 18%, 10-year overall mortality 47% vs. 40%; p < 0.001), and this difference persisted (p = 0.01) after adjusting for multiple clinical variables and the SSS. Conclusions: Screening for CAD using stress SPECT in asymptomatic AF patients has a yield similar to age- and gender-matched control patients without AF. Although SSS predicts mortality in patients with and without AF, patients with AF have increased total mortality independent of the findings on stress SPECT. These results suggest that factors other than obstructive CAD are responsible for the increased mortality in AF.

AB - Objectives: We sought to determine if screening for coronary artery disease (CAD) with stress single-photon emission computed tomography (SPECT) is of value in patients with atrial fibrillation (AF) who do not have symptoms of chest pain or dyspnea. Background: Although noninvasive stress testing is often done to screen for CAD in asymptomatic patients with AF and is considered to be appropriate in selected patients, its potential utility has not been demonstrated. Methods: A retrospective study was conducted of 374 asymptomatic patients with AF referred for the detection of CAD. Mean follow-up was 5.7 ± 3.8 years. The study group was compared with a control group of 374 asymptomatic age and gender-matched patients without AF. Results: The mean summed stress score (SSS) was not significantly different between AF patients and control subjects (3.6 ± 5.3 vs. 3.5 ± 5.9; p = 0.35). Compared with controls, asymptomatic AF patients had similar rates of abnormal SPECT studies (51.6% vs. 48.4%; p = 0.38) and high-risk studies (14.4% vs. 14.4%; p = 1.0). The SSS was a significant predictor of outcome in both AF patients and control subjects. However, total mortality was significantly greater in AF patients (5-year overall mortality 27% vs. 18%, 10-year overall mortality 47% vs. 40%; p < 0.001), and this difference persisted (p = 0.01) after adjusting for multiple clinical variables and the SSS. Conclusions: Screening for CAD using stress SPECT in asymptomatic AF patients has a yield similar to age- and gender-matched control patients without AF. Although SSS predicts mortality in patients with and without AF, patients with AF have increased total mortality independent of the findings on stress SPECT. These results suggest that factors other than obstructive CAD are responsible for the increased mortality in AF.

UR - http://www.scopus.com/inward/record.url?scp=34548388506&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548388506&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2007.05.035

DO - 10.1016/j.jacc.2007.05.035

M3 - Article

C2 - 17825719

AN - SCOPUS:34548388506

VL - 50

SP - 1080

EP - 1085

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 11

ER -