PURPOSE Our study assesses the routine reporting of exercise ischemia using very low-dose exercise-first myocardial perfusion SPECT in a large number of patients and under real-life conditions, by evaluating correlations with the subsequent routine reporting of coronary stenosis by angiography and with factors that predict ischemia. METHODS Data from 13,126 routine exercise MPI reports, from 11,952 patients (31% women), using very low doses of sestamibi and a high-sensitivity cardiac CZT camera, were extracted to assess the reporting of significant MPI-ischemia (> 1 left ventricular segment), to determine the MPI normalcy rate in a group with < 5% pretest probability of coronary artery disease (CAD) (n = 378), and to assess the ability of MPI to predict a > 50% coronary stenosis in patients with available coronary angiography reports in the 3 months after the MPI (n = 713). RESULTS The median effective patient dose was 2.51 [IQR: 1.00-4.71] mSv. The normalcy rate was 98%, and the MPI-ischemia rate was independently predicted by a known CAD, the male gender, obesity, and a < 50% LV ejection fraction, ranging from 29.5% with all these risk factors represented to 1.5% when there were no risk factors. A > 50% coronary stenosis was significantly predicted by MPI-ischemia, less significantly for mild (odds ratio [95% confidence interval]: 1.61 [1.26-1.96]) than for moderate-to-severe MPI-ischemia (4.05 [3.53-4.57]) and was also impacted by having a known CAD (2.17 [1.83-2.51]), by a submaximal exercise test (1.48 [1.15-1.81]) and being ≥ 65 years of age (1.43 [1.11-1.76]). CONCLUSION Ischemia detected using a very low-dose exercise-first MPI protocol in a large-scale clinical cohort and under real-life routine conditions is a highly significant predictor for the subsequent reporting of coronary stenosis, although this prediction is enhanced by other variables. This weakly irradiating approach is amenable to being repeated at shorter time intervals, in target patient groups with a high probability of MPI-ischemia.

中文翻译：

---

评估来自大规模真实世界队列的极低剂量运动优先心肌灌注 SPECT 的常规报告以及与随后在血管造影中报告的冠状动脉狭窄的相关性。

目的 我们的研究通过评估与随后通过血管造影报告的冠状动脉狭窄的常规报告和因素的相关性，在大量患者和现实生活条件下使用极低剂量运动先心肌灌注 SPECT 评估运动缺血的常规报告预测缺血。方法 提取来自 11,952 名患者（31% 女性）的 13,126 例常规运动 MPI 报告的数据，使用极低剂量的 sestamibi 和高灵敏度心脏 CZT 相机，以评估显着 MPI 缺血（> 1 个左心室节段）的报告)，以确定冠状动脉疾病 (CAD) 的预测概率 < 5% (n = 378) 的组中的 MPI 正常率，并评估 MPI 预测 a > 在 MPI 后 3 个月内，有可用冠状动脉造影报告的患者中有 50% 的冠状动脉狭窄（n = 713）。结果 中位有效患者剂量为 2.51 [IQR: 1.00-4.71] mSv。正常率为 98%，MPI 缺血率由已知 CAD、男性、肥胖和 LV 射血分数 < 50% 独立预测，范围从 29.5%（所有这些风险因素代表）到 1.5%没有风险因素。A > 50% 的冠状动脉狭窄可通过 MPI 缺血显着预测，轻度（比值比 [95% 置信区间]：1.61 [1.26-1.96]）比中度至重度 MPI 缺血（4.05 [3.53- 4.57]）并且还受到已知 CAD (2.17 [1.83-2.51])、次最大运动测试 (1.48 [1.15-1.81]) 和 ≥ 65 岁 (1.43 [1.11-1.76]) 的影响。结论 在大规模临床队列和现实生活常规条件下，使用极低剂量运动优先 MPI 方案检测到的缺血是随后报告冠状动脉狭窄的非常重要的预测因子，尽管其他变量增强了该预测。这种弱照射方法可以在更短的时间间隔内重复，在 MPI 缺血概率高的目标患者群体中。