This Podcast Will Forever Change How You View Normal Exercise Stress MPI Studies

In Episode 8 of JNC CardioConnect, these physicians discuss findings from new research with significant clinical and research implications.

Finding certain additive abnormal clinical markers on a normal, or “negative,” exercise SPECT myocardial perfusion imaging offers valuable prognostic information and could inform clinical decision-making in important new ways, according to new research published in this month’s Journal of Nuclear Cardiology (JNC) and featured in Episode 8 of the JNC CardioConnect podcast.

The Study: Steven C. Scherping, III, MD, and colleagues in the Bourque lab at the University of Virginia conducted a retrospective observational study of patients who had a normal exercise SPECT MPI study, 83 percent of whom had cardiac or possibly cardiac symptoms. The investigators’ goal, says Dr. Scherping, was to understand “how to improve risk stratification in this very representative patient population above perfusion imaging alone or when that perfusion imaging is normal.”

The study showed the abnormal markers were highly prevalent in the study population and there was a stepwise increase in all-cause mortality and non-fatal myocardial infarction corresponding to the number of markers present. Each additional marker on the treadmill test was associated with a 36 percent relative increase in the event rate.

The Implications: These findings have significant clinical and research implications, says Jamieson M. Bourque, MD, MHS, FASNC, the study’s senior author and ASNC’s president-elect. “In addition to providing further rationale for using functional testing, the presence of these abnormal markers could be used to identify patients who would benefit from further studies, such as cardiac PET, or in which patients to really double down on risk factor modification.”

The JNC CardioConnect podcast brings Drs. Bourque and Scherping together with JNC Editor-in-Chief Marcelo F. Di Carli, MD, MASNC, and Diana M. López, MD, author of the study’s accompanying editorial, for a conversation that reveals what the markers are (good news – they are already in your stress test results!), what they mean, and why they matter.

“This study reminds us that ruling out overt obstructive coronary artery disease, while important, is often just the beginning, not the end, of the evaluation for our patients,” Dr. López says. She and Dr. Bourque view the results as a “call to action” to better highlight exercise abnormalities on reports sent to referrers.

“This is great science that underscores why we should be doing exercise stress testing,” Dr. Di Carli says, “It also has implications for both SPECT and PET MPI, especially as we begin to introduce F-18 flurpiridaz in clinical practice.”

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