Enhanced prognostic stratification of patients with left ventricular hypertrophy with the use of single-photon emission computed tomography

Background Patients with left ventricular hypertrophy (LVH) are at increase d risk of future cardiovascular events. Little is known about risk stratifi cation of these patients with the use of myocardial perfusion imaging. This study sought to assess the prognostic stratification of patients with LVH by using myocardial perfusion single-photon emission computed tomography (S PECT). Methods and Results We studied 633 consecutive patients with electrocardiog raphic evidence of LVH who underwent dual isotope myocardial perfusion SPEC T (rest thallium 201/stress technetium 99m sestamibi) and were followed up for a mean period of 22 +/- 7 months. During the follow-up period, 67 event s (35 cardiac deaths and 32 nonfatal myocardial infarctions) occurred (6% a nnual event rate). The results of the perfusion scan significantly risk-str atified the population; patients with normal scans had a low rate of nonfat al myocardial infarction and cardiac death (<1% per year of follow-up). The rates of cardiac events increased significantly as a function of the scan result: 4.9% in patients with mildly abnormal scans and 10.3% in moderately to severely abnormal scans. Cox proportional hazards analysis demonstrated that after adjusting for pretest likelihood of coronary artery disease (th e most predictive clinical variable; chi(2) = 15.5, P < .001), summed stres s score (the most predictive nuclear variable; chi(2) = 18, P < .0001) adde d significant incremental prognostic information (global chi(2) increased f rom 15.5 to 36; P < .001). Conclusions In patients with LVH with an overall high cardiac event rate, S PECT provided enhanced stratification by adding significant incremental pro gnostic information over clinical and historic variables.