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Article ; Online: Comparative predictors of mortality among patients referred for stress single-photon emission computed tomography versus positron emission tomography myocardial perfusion imaging.

Rozanski, Alan / Miller, Robert J H / Han, Donghee / Gransar, Heidi / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

2024 Volume 32, Page(s) 101811

Abstract: Background: There is currently little information regarding the usage and comparative predictors of mortality among patients referred for single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) myocardial perfusion ... ...

Abstract	Background: There is currently little information regarding the usage and comparative predictors of mortality among patients referred for single-photon emission computed tomography (SPECT) versus positron emission tomography (PET) myocardial perfusion imaging (MPI) within multimodality imaging laboratories. Methods: We compared the clinical characteristics and mortality outcomes among 15,718 patients referred for SPECT-MPI and 6202 patients referred for PET-MPI between 2008 and 2017. Results: Approximately two-thirds of MPI studies were performed using SPECT-MPI. The PET-MPI group was substantially older and included more patients with known coronary artery disease (CAD), hypertension, diabetes, and myocardial ischemia. The annualized mortality rate was also higher in the PET-MPI group, and this difference persisted after propensity matching 3615 SPECT-MPI and 3615 PET-MPI patients to have similar clinical profiles. Among the SPECT-MPI patients, the most potent predictor of mortality was exercise ability and performance, including consideration of patients' mode of stress testing and exercise duration. Among the PET-MPI patients, myocardial flow reserve (MFR) was the most potent predictor of mortality. Conclusions: In our real-world setting, PET-MPI was more commonly employed among older patients with more cardiac risk factors than SPECT-MPI patients. The most potent predictors of mortality in our SPECT and PET-MPI groups were variables exclusive to each test: exercise ability/capacity for SPECT-MPI patients and MFR for PET-MPI patients.
MeSH term(s)	Humans ; Myocardial Perfusion Imaging ; Positron-Emission Tomography ; Tomography, Emission-Computed, Single-Photon ; Coronary Artery Disease/diagnostic imaging ; Exercise
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1212505-2
ISSN	1532-6551 ; 1071-3581
ISSN (online)	1532-6551
ISSN	1071-3581
DOI	10.1016/j.nuclcard.2024.101811
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Zs.A 4121: Show issues

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Article ; Online: Is typical angina still prognostically important? The influence of "treatment bias" upon prognostic assessments.

Rozanski, Alan / Han, Donghee / Miller, Robert J H / Gransar, Heidi / Hayes, Sean W / Friedman, John D / Thomson, Louise / Berman, Daniel S

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

2023 Volume 31, Page(s) 101778

Abstract: Background: Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance.: Methods: We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 ...

Abstract	Background: Since typical angina has become less frequent, it is unclear if this symptom still has prognostic significance. Methods: We evaluated 38,383 patients undergoing stress/rest SPECT myocardial perfusion imaging followed for a median of 10.9 years. After dividing patients by clinical symptoms, we evaluated the magnitude of myocardial ischemia and subsequent mortality among medically treated versus revascularized subgroups following testing. Results: Patients with typical angina had more frequent and greater ischemia than other symptom groups, but not higher mortality. Among typical angina patients, those who underwent early revascularization had substantially greater ischemia than the medically treated subgroup, including a far higher proportion with severe ischemia (44.9% vs 4.3%, P < 0.001) and transient ischemic dilation of the LV (31.3% vs 4.7%, P < 0.001). Nevertheless, the revascularized typical angina subgroup had a lower adjusted mortality risk than the medically treated subgroup (HR = 0.72, 95% CI: 0.57-0.92, P = 0.009) CONCLUSIONS: Typical angina is associated with substantially more ischemia than other clinical symptoms. However, the high referral of patients with typical angina patients with ischemia to early revascularization resulted in this group having a lower rather than higher mortality risk versus other symptom groups. These findings illustrate the need to account for "treatment bias" among prognostic studies.
MeSH term(s)	Humans ; Prognosis ; Angina Pectoris/diagnostic imaging ; Angina Pectoris/therapy ; Myocardial Ischemia ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Ischemia
Language	English
Publishing date	2023-12-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1212505-2
ISSN	1532-6551 ; 1071-3581
ISSN (online)	1532-6551
ISSN	1071-3581
DOI	10.1016/j.nuclcard.2023.101778
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Article ; Online: Native SEC and Reversed-Phase LC-MS Reveal Impact of Fab Glycosylation of Anti-SARS-COV-2 Antibodies on Binding to the Receptor Binding Domain.

Woodall, Daniel W / Thomson, Christy A / Dillon, Thomas M / McAuley, Arnold / Green, Lydia B / Foltz, Ian N / Bondarenko, Pavel V

Analytical chemistry

2023 Volume 95, Issue 42, Page(s) 15477–15485

Abstract: The binding affinity of monoclonal antibodies (mAbs) for their intended therapeutic targets is often affected by chemical and post-translational modifications in the antigen binding (Fab) domains. A new two-dimensional analytical approach is described ... ...

Abstract	The binding affinity of monoclonal antibodies (mAbs) for their intended therapeutic targets is often affected by chemical and post-translational modifications in the antigen binding (Fab) domains. A new two-dimensional analytical approach is described here utilizing native size exclusion chromatography (SEC) to separate populations of antibodies and bound antibody-antigen complexes for subsequent characterization of these modifications by reversed-phase (RP) liquid chromatography-mass spectrometry (LC-MS) at the intact antibody level. Previously, we utilized peptide mapping to measure modifications impacting binding. However, in this study, the large size of the modification (N-glycosylation) allowed assessing its impact from small amounts (∼20 ug) of intact antibody, without the need for peptide mapping. Here, we apply the native SEC-based competitive binding assay to quickly and qualitatively investigate the effects of Fab glycosylation of four antispike protein mAbs that were developed for use in the treatment of COVID-19 disease. Three of the mAbs were observed to have consensus N-glycosylation sites (N-X-T/S) in the Fab domains, a relatively rare occurrence in therapeutic mAbs. The goal of the study was to characterize the levels of Fab glycosylation present, as well as determine the impact of glycosylation on binding to the spike protein receptor binding domain (RBD) and the ability of the mAbs to inhibit RBD-ACE2 interaction at the intact antibody level, with minimal sample treatment and preparation. The three mAbs with Fab N-glycans were found to have glycosylation profiles ranging from full occupancy at each Fab (in one mAb) to partially glycosylated with mixed populations of two, one, or no glycan moieties. Competitive SEC analysis of mAb-RBD revealed that the glycosylated antibody populations outcompete their nonglycosylated counterparts for the available RBD molecules. This competitive SEC binding analysis was applied to investigate the three-body interaction of a glycosylated mAb blocking the interaction between endogenous binding partners RBD-ACE2, finding that both glycosylated and nonglycosylated mAb populations bound to RBD with high enough affinity to block RBD-ACE2 binding.
MeSH term(s)	Humans ; Glycosylation ; COVID-19 ; Chromatography, Liquid ; Angiotensin-Converting Enzyme 2/metabolism ; Tandem Mass Spectrometry ; Antibodies, Viral ; Protein Binding ; Chromatography, Gel
Chemical Substances	Angiotensin-Converting Enzyme 2 (EC 3.4.17.23) ; Antibodies, Viral
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1508-8
ISSN	1520-6882 ; 0003-2700
ISSN (online)	1520-6882
ISSN	0003-2700
DOI	10.1021/acs.analchem.2c05554
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Zs.A 4033: Show issues

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Article ; Online: 10-year experience of utilizing a stress-first SPECT myocardial perfusion imaging.

Han, Donghee / Hyun, Mark C / Miller, Robert J H / Gransar, Heidi / Slomka, Piotr J / Dey, Damini / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S / Rozanski, Alan

International journal of cardiology

2024 Volume 401, Page(s) 131863

Abstract: Background: Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).: Methods! ...

Abstract	Background: Despite its potential benefits, the utilization of stress-only protocol in clinical practice has been limited. We report utilizing stress-first single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Methods: We assessed 12,472 patients who were referred for SPECT-MPI between 2013 and 2020. The temporal changes in frequency of stress-only imaging were assessed according to risk factors, mode of stress, prior coronary artery disease (CAD) history, left ventricular function, and symptom status. The clinical endpoint was all-cause mortality. Results: In our lab, stress/rest SPECT-MPI in place of rest/stress SPECT-MPI was first introduced in November 2011 and was performed more commonly than rest/stress imaging after 2013. Stress-only SPECT-MPI scanning has been performed in 30-34% of our SPECT-MPI studies since 2013 (i.e.. 31.7% in 2013 and 33.6% in 2020). During the study period, we routinely used two-position imaging (additional prone or upright imaging) to reduce attenuation and motion artifact and introduced SPECT/CT scanner in 2018. The rate of stress-only study remained consistent before and after implementing the SPECT/CT scanner. The frequency of stress-only imaging was 43% among patients without a history of prior CAD and 19% among those with a prior CAD history. Among patients undergoing treadmill exercise, the frequency of stress-only imaging was 48%, while 32% among patients undergoing pharmacologic stress test. In multivariate Cox analysis, there was no significant difference in mortality risk between stress-only and stress/rest protocols in patients with normal SPECT-MPI results (p = 0.271). Conclusion: Implementation of a stress-first imaging protocol has consistently resulted in safe cancellation of 30% of rest SPECT-MPI studies.
MeSH term(s)	Humans ; Myocardial Perfusion Imaging/methods ; Tomography, Emission-Computed, Single-Photon/methods ; Coronary Artery Disease/diagnosis ; Risk Factors ; Exercise Test
Language	English
Publishing date	2024-02-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2024.131863
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Zs.A 1673: Show issues

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Article ; Online: Self-reported exercise activity influences the relationship between coronary computed tomography angiographic finding and mortality.

Natanzon, Sharon Shalom / Han, Donghee / Kuronuma, Keiichiro / Gransar, Heidi / Miller, Robert J H / Slomka, Piotr J / Dey, Damini / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S / Rozanski, Alan

Journal of cardiovascular computed tomography

2024

Abstract: Aim: Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic ... ...

Abstract	Aim: Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA). Methods and results: We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n = 1643, 17%), mild exercise (n = 3156, 32%), moderate exercise (n = 3542, 36%), and high exercise (n = 1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p < 0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p < 0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p = 0.912). Conclusion: Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.
Language	English
Publishing date	2024-04-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2394360-9
ISSN	1876-861X ; 1934-5925
ISSN (online)	1876-861X
ISSN	1934-5925
DOI	10.1016/j.jcct.2024.03.011
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Zs.A 6761: Show issues

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Article ; Online: Endogenous microRNA sponges: evidence and controversy.

Thomson, Daniel W / Dinger, Marcel E

Nature reviews. Genetics

2016 Volume 17, Issue 5, Page(s) 272–283

Abstract: The competitive endogenous RNA (ceRNA) hypothesis proposes that transcripts with shared microRNA (miRNA) binding sites compete for post-transcriptional control. This hypothesis has gained substantial attention as a unifying function for long non-coding ... ...

Abstract	The competitive endogenous RNA (ceRNA) hypothesis proposes that transcripts with shared microRNA (miRNA) binding sites compete for post-transcriptional control. This hypothesis has gained substantial attention as a unifying function for long non-coding RNAs, pseudogene transcripts and circular RNAs, as well as an alternative function for messenger RNAs. Empirical evidence supporting the hypothesis is accumulating but not without attracting scepticism. Recent studies that model transcriptome-wide binding-site abundance suggest that physiological changes in expression of most individual transcripts will not compromise miRNA activity. In this Review, we critically evaluate the evidence for and against the ceRNA hypothesis to assess the impact of endogenous miRNA-sponge interactions.
MeSH term(s)	Animals ; Gene Expression Regulation ; Humans ; MicroRNAs/genetics ; Pseudogenes ; RNA Interference ; RNA, Long Noncoding/genetics ; Transcriptome
Chemical Substances	MicroRNAs ; RNA, Long Noncoding
Language	English
Publishing date	2016-05
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2035157-4
ISSN	1471-0064 ; 1471-0056
ISSN (online)	1471-0064
ISSN	1471-0056
DOI	10.1038/nrg.2016.20
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Zs.A 5474: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: The iSTOPP study: Protocol for a proof-of-concept randomised clinical trial of sensory discrimination training in people with persistent neck pain.

Harvie, Daniel S / Olthof, Nick / Hams, Andrea / Thomson, Hayley / Coppieters, Michel W

Contemporary clinical trials communications

2021 Volume 23, Page(s) 100820

Abstract: Background: Neck pain can be associated with a reduction in tactile acuity that is thought to reflect disrupted sensory processing. Tactile acuity training may normalise sensory processing and improve symptoms. This proof-of-concept trial will assess ... ...

Abstract	Background: Neck pain can be associated with a reduction in tactile acuity that is thought to reflect disrupted sensory processing. Tactile acuity training may normalise sensory processing and improve symptoms. This proof-of-concept trial will assess the feasibility of a novel tactile acuity training method and whether this intervention improves tactile acuity in people with persistent neck pain. Methods: and analysis: In this two-arm randomised clinical proof-of-concept trial we will recruit participants with neck pain receiving usual care physiotherapy in a secondary outpatient healthcare setting. Thirty-six participants will be randomised 2:1 to receive four weeks of either tactile acuity training using the Imprint Tactile Acuity Device (iTAD) or a placebo intervention, in addition to usual care. The placebo intervention will consist of a de-activated TENS machine (iTENS) said to deliver a sub-threshold inhibitory therapy. Outcomes will be assessed at baseline, mid-treatment, and at 5-weeks and 2-months follow-up. The primary outcome tactile acuity will be evaluated using the two-point discrimination test and locognosia tests. Feasibility will be informed by recruitment and attrition rates, adherence, credibility of the interventions, treatment satisfaction and blinding. Pain intensity and anatomical spread will be analysed as secondary outcomes. The effect of iTAD training on tactile acuity will be assessed using a 2 (Group: iTAD vs. iTENS) x 4 (Time: baseline, mid-treatment, 5-week and 2-month outcome assessment) mixed ANOVA. Secondary outcomes including pain and pain spread, will be analysed with a focus on informing sample size calculations in future trials. Ethics and dissemination: Risks associated with this study are minor. Usual care is not withheld, and participants consent to random allocation of either iTAD or iTENS. Potential benefits to participants include any benefit associated with the interventions and contributing to research that may assist people with chronic pain in the future. Trial results will be disseminated via academic journals and conference presentations. The study is approved by the Human Research Ethics Committee of Griffith University (2017/128).
Language	English
Publishing date	2021-07-14
Publishing country	Netherlands
Document type	Journal Article
ISSN	2451-8654
ISSN (online)	2451-8654
DOI	10.1016/j.conctc.2021.100820
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Article ; Online: Downward myocardial creep during stress PET imaging is inversely associated with mortality.

Kuronuma, Keiichiro / Miller, Robert J H / Wei, Chih-Chun / Singh, Ananya / Lemley, Mark H / Van Kriekinge, Serge D / Kavanagh, Paul B / Gransar, Heidi / Han, Donghee / Hayes, Sean W / Thomson, Louise / Dey, Damini / Friedman, John D / Berman, Daniel S / Slomka, Piotr J

European journal of nuclear medicine and molecular imaging

2024 Volume 51, Issue 6, Page(s) 1622–1631

Abstract: Purpose: The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction ... ...

Abstract	Purpose: The myocardial creep is a phenomenon in which the heart moves from its original position during stress-dynamic PET myocardial perfusion imaging (MPI) that can confound myocardial blood flow measurements. Therefore, myocardial motion correction is important to obtain reliable myocardial flow quantification. However, the clinical importance of the magnitude of myocardial creep has not been explored. We aimed to explore the prognostic value of myocardial creep quantified by an automated motion correction algorithm beyond traditional PET-MPI imaging variables. Methods: Consecutive patients undergoing regadenoson rest-stress [ Results: A total of 4,276 patients (median age 71 years; 60% male) were analyzed, and 1,007 ACM events were documented during a 5-year median follow-up. Processing time for automatic motion correction was < 12 s per patient. Myocardial creep in the superior to inferior (downward) direction was greater than the other directions (median, 4.2 mm vs. 1.3-1.7 mm). Annual mortality rates adjusted for age and sex were reduced with a larger downward creep, with a 4.2-fold ratio between the first (0 mm motion) and 10th decile (11 mm motion) (mortality, 7.9% vs. 1.9%/year). Downward creep was associated with lower ACM after full adjustment for clinical and imaging parameters (adjusted hazard ratio, 0.93; 95%CI, 0.91-0.95; p < 0.001). Adding downward creep to the standard PET-MPI imaging model significantly improved ACM prediction (area under the receiver operating characteristics curve, 0.790 vs. 0.775; p < 0.001), but other directions did not (p > 0.5). Conclusions: Downward myocardial creep during regadenoson stress carries additional information for the prediction of ACM beyond conventional flow and perfusion PET-MPI. This novel imaging biomarker is quantified automatically and rapidly from stress dynamic PET-MPI.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Myocardial Perfusion Imaging/methods ; Positron-Emission Tomography ; Heart/diagnostic imaging ; Middle Aged ; Myocardium/pathology ; Rubidium Radioisotopes ; Stress, Physiological ; Prognosis
Chemical Substances	Rubidium Radioisotopes
Language	English
Publishing date	2024-01-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8236-3
ISSN	1619-7089 ; 0340-6997 ; 1619-7070
ISSN (online)	1619-7089
ISSN	0340-6997 ; 1619-7070
DOI	10.1007/s00259-024-06611-2
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Zs.A 1227: Show issues

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Article ; Online: Haptoglobin Attenuates Cerebrospinal Fluid Hemoglobin-Induced Neurological Deterioration in Sheep.

Thomson, Bart R / Schwendinger, Nina / Beckmann, Katrin / Gentinetta, Thomas / Couto, Daniel / Wymann, Sandra / Verdon, Valérie / Buzzi, Raphael M / Akeret, Kevin / Kronen, Peter W / Weinberger, Eva M / Held, Ulrike / Seehusen, Frauke / Richter, Henning / Schaer, Dominik J / Hugelshofer, Michael

Translational stroke research

2024

Abstract: Secondary brain injury (SBI) occurs with a lag of several days post-bleeding in patients with aneurysmal subarachnoid hemorrhage (aSAH) and is a strong contributor to mortality and long-term morbidity. aSAH-SBI coincides with cell-free hemoglobin (Hb) ... ...

Abstract	Secondary brain injury (SBI) occurs with a lag of several days post-bleeding in patients with aneurysmal subarachnoid hemorrhage (aSAH) and is a strong contributor to mortality and long-term morbidity. aSAH-SBI coincides with cell-free hemoglobin (Hb) release into the cerebrospinal fluid. This temporal association and convincing pathophysiological concepts suggest that CSF-Hb could be a targetable trigger of SBI. However, sparse experimental evidence for Hb's neurotoxicity in vivo defines a significant research gap for clinical translation. We modeled the CSF-Hb exposure observed in aSAH patients in conscious sheep, which allowed us to assess neurological functions in a gyrencephalic species. Twelve animals were randomly assigned for 3-day bi-daily intracerebroventricular (ICV) injections of either Hb or Hb combined with the high-affinity Hb scavenger protein haptoglobin (Hb-Hp, CSL888). Repeated CSF sampling confirmed clinically relevant CSF-Hb concentrations. This prolonged CSF-Hb exposure over 3 days resulted in disturbed movement activity, reduced food intake, and impaired observational neuroscores. The Hb-induced neurotoxic effects were significantly attenuated when Hb was administered with equimolar haptoglobin. Preterminal magnetic resonance imaging (MRI) showed no CSF-Hb-specific structural brain alterations. In both groups, histology demonstrated an inflammatory response and revealed enhanced perivascular histiocytic infiltrates in the Hb-Hp group, indicative of adaptive mechanisms. Heme exposure in CSF and iron deposition in the brain were comparable, suggesting comparable clearance efficiency of Hb and Hb-haptoglobin complexes from the intracranial compartment. We identified a neurological phenotype of CSF-Hb toxicity in conscious sheep, which is rather due to neurovascular dysfunction than structural brain injury. Haptoglobin was effective at attenuating CSF-Hb-induced neurological deterioration, supporting its therapeutic potential.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2541897-X
ISSN	1868-601X ; 1868-4483
ISSN (online)	1868-601X
ISSN	1868-4483
DOI	10.1007/s12975-024-01254-9
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Article ; Online: Increasing frequency of dyspnea among patients referred for cardiac stress testing.

Rozanski, Alan / Gransar, Heidi / Sakul, Sakul / Miller, Robert J H / Han, Donghee / Hayes, Sean W / Friedman, John D / Thomson, Louise E J / Berman, Daniel S

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

2023 Volume 30, Issue 6, Page(s) 2303–2313

Abstract: Objective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.: Patients and methods: We evaluated the prevalence of dyspnea and its relationship to ... ...

Abstract	Objective: To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing. Patients and methods: We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups. Results: The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup. Conclusions: Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.
MeSH term(s)	Humans ; Exercise Test/adverse effects ; Chest Pain/diagnosis ; Prognosis ; Tomography, Emission-Computed, Single-Photon/adverse effects ; Dyspnea/diagnosis ; Dyspnea/etiology ; Myocardial Perfusion Imaging/adverse effects ; Coronary Artery Disease/complications
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	1212505-2
ISSN	1532-6551 ; 1071-3581
ISSN (online)	1532-6551
ISSN	1071-3581
DOI	10.1007/s12350-023-03375-4
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