Stress imaging tests predict prognosis of heart disease in obese persons

Widely used nuclear medicine procedure may pinpoint risk of those with 'silent' disease, says study in August Journal of Nuclear Medicine

Reston, Va. -- Researchers identified an accurate method that may detect whether obese individuals have a low, intermediate or high risk of coronary artery disease, the leading cause of death in the United States, notes a report in the August issue of the Journal of Nuclear Medicine.

"Stress myocardial perfusion imaging (or stress testing)--with better imaging quality made possible by using technetium-labeled agents--has apparently resulted in improved detection of coronary artery disease in obese patients," said Abdou Elhendy, an associate professor of medicine in the cardiology section at the Marshfield Clinic in Marshfield, Wis. "This can be helpful for physicians in planning management strategy," added the co-author of "Prognostic Stratification of Obese Patients by Stress 99mTc-Tetrofosmin Myocardial Perfusion Imaging."

Individuals with coronary artery disease have less blood flowing to the heart during stress because their arteries have become hardened and narrowed. This condition puts about 13 million Americans at risk every year for angina (chest pain), heart attack, heart failure and death. About half a million Americans will die from coronary artery disease, "which may be silent particularly in patients with diminished physical activity," said Elhendy, who is also affiliated to the Thoraxcenter at the University Hospital Rotterdam in the Netherlands.

Currently, detecting the blockage of coronary arteries is based on an invasive procedure called coronary angiography. "Stress testing is proven useful in obese patients who have symptoms and/or other risk factors for coronary artery disease and can serve as a gatekeeper for that invasive and expensive procedure," Elhendy noted. "Stress myocardial perfusion imaging--with 99mTc-tetrofosmin--can effectively risk stratify obese patients and guide the selection of those who may require invasive intervention," he stated.

Heart problems can be easier to diagnose when the heart is working harder and beating faster than when it is at rest. During stress testing, an individual exercises (or is given a pharmacologic stress agent if unable to exercise) to make the heart work harder and beat faster while blood flow to the heart is being examined. The research team from the Netherlands used stress testing with exercise or a pharmacologic stress agent (dobutamine in conjunction with radiolabeled tetrofosmin, a widely available radiotracer) to assess perfusion (blood flow) to the heart muscle and determine risk of heart events in obese patients.

"Prognostic Stratification of Obese Patients by Stress 99mTc-Tetrofosmin Myocardial Perfusion Imaging" appears in the August issue of the Journal of Nuclear Medicine, which is published by SNM. Besides Elhendy, co-authors include Arend F.L. Schinkel, Ron T. van Domburg, Elena Biagini and Don Poldermans, all with Thoraxcenter, University Hospital Rotterdam, Rotterdam, the Netherlands; Jeroen J. Bax, Leiden University Hospital, the Netherlands; and Roelf Valkema, nuclear medicine department at the University Hospital Rotterdam, the Netherlands.

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To obtain a copy of this article and related images, please contact Maryann Verrillo by phone at (703) 708-9000, ext. 1211, or send an e-mail to mverrillo@snm.org. Current and past issues of the Journal of Nuclear Medicine can be found online at jnm.snmjournals.org. Print copies can be obtained by contacting the SNM Service Center, Society of Nuclear Medicine, 1850 Samuel Morse Drive, Reston, VA 20190-5316; phone (800) 513-6853; e-mail servicecenter@snm.org; fax (703) 708-9015. A subscription to the journal is an SNM member benefit.

About SNM--Advancing Molecular Imaging and Therapy SNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular and nuclear imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed journal in the field (the Journal of Nuclear Medicine); host the premier annual meeting for medical imaging; sponsor research grants, fellowships and awards; and train physicians, technologists, scientists, physicists, chemists and radiopharmacists in state-of-the-art imaging procedures and advances. SNM members have introduced--and continue to explore--biological and technological innovations in medicine that noninvasively investigate the molecular basis of diseases, benefiting countless generations of patients. SNM is based in Reston, Va.; additional information can be found online at www.snm.org.


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