1 A REDUCTION IN EJECTION FRACTION DURING STRESS WITHIN THE NORMAL RANGE WITH GATED SPECT IMAGING IS NOT ASSOCIATED WITH INCREASED MORTALITY
I. Opoku-Asare1,2, B. Curry1, B. Shamloo2, J. Morrissette2, K. O'Regan2, E. Goheen2, G. Trachiotis3, P. Kokkinos2, M. Greenberg1,2 1Cardiology, Howard University Hospital, Washington, DC 2Cardiology, Washington DC VA Medical Center, Washington, DC 3Cardiothoracic Surgery, Washington DC VA Medical Center, Washington, DC.
Purpose of Study: We sought to establish the prognostic significance of a stress induced fall in ejection fraction ≥10 in patients with normal resting baseline systolic function whose ejection fraction(EF) falls with stress but remains within the normal range.
Methods Used: 5,600 patients underwent gated, nuclear myocardial SPECT stress testing over a period of 6 years. Patients were followed prospectively and mortality assessed from the centralized Veterans Affairs electronic medical record (CPRS-VISTA). All cause mortality was compared between patients with normal systolic function where a post stress EF remained unchanged and those patients whose post stress EF remained within the normal range but decreased by ≥10.
Summary of Results: A total of 1441 patients had a normal resting systolic function that remained unchanged with stress while 139 patients demonstrated a stress induced fall in EF ≥10 while still remaining within the normal range (>=46%). Both groups were similar with respect to age (63 ± 14; 65 ± 12 yrs), weight (197 ± 46;199 ± 52 lbs), and resting blood pressure (128 ± 20; 128 ± 20 mmHg; p=ns). Resting EF was significantly higher (59 ± 8%; 68 ± 7%; p < 0.05) in those pts where stress induced EF fall of ≥10 while still remaining in the normal range. During a follow up period of 6 yrs survival was 94% at 1 yr, 85% at 3 yrs, & 78% at 5 yrs with no differences between the two …