Therapeutic and Prognostic Value of Silent Myocardial Ischemia in Intermediate and High Risk Patients without Known Coronary Artery Disease Terapiska I Prognosticka Vrednost Asimptomatske Miokardne Ishemije Kod Pacijenata Sa Umerenim I Visokim Kardiovaskularnim Rizikom Bez Poznate Koronarne Arterijske Bolesti

Aim: To evaluate the presence of myocardial ischemia in asymptomatic patients with intermediate and high cardiovascular (CV) risk without previously known coronary artery disease (CAD) and the value of ischemia on therapeutic decision and prognosis. Materials and methods: 75 asymptomatic patients (35 with intermediate and 40 patients with high CV risk-SCORE risk system), underwent SPECT myocardial perfusion imaging (MPI) for detection of suspected CAD. We used 17 segment model for scan perfusion and function analysis using perfusion scores. All patients have full blood laboratory analyses including lipid values, and presence of urine albuminuria. Patients were followed up for 18 months for cardiovascular events (new chest pain, hospitalization for acute coronary syndrome, revascularization, cardiac death). Logistic regression analysis was used to assess predictive parameters for myocardial ischemia and cardiovascular events. Results: All patients have normal rest left ventricular function with EF >55%. SPECT MPI was performed in 60 patients. 12/60 patients (20%) had stress induced ischemia and 4 patients fixed defects. Mild ischemia was found in 6 patients summed stress score (SDS) <4, moderate in 4 and severe ischemia in 2 patients. Severe ischemia was only related to the duration of diabetes. Stepwise logistic regression analysis for prediction of stress induced ischemia showed OR 2.4 (95% CI 1.7–3.6) for stress induced ECG changes, OR 2.8 for CAC >400 (95% CI 1.9-3.2) and OR 3.9 for presence of DM over 10y (95% CI 2.3?6.6). Patients with at least moderate ischemia were referred for coronary angiography. Conclusion: SPECT myocardial perfusion imaging is valuable technique for detection of silent CAD in intermediate and high risk patients, which can risk stratify patients and guide management decision and.