{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:51:34Z","timestamp":1791924694799,"version":"4.3.4"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,10,8]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Appropriate use criteria (AUC) have been developed to aid in the optimal use of single-photon emission computed tomography (SPECT)\u2013myocardial perfusion imaging (MPI), a technique that is a mainstay of risk assessment for ischemic heart disease. The impact of appropriate use on the prognostic value of SPECT-MPI is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              A prospective cohort study of 1511 consecutive patients undergoing outpatient, community-based SPECT-MPI was conducted. Subjects were stratified on the basis of the 2009 AUC for SPECT-MPI into an appropriate or uncertain appropriateness group and an inappropriate group. Patients were prospectively followed up for 27\u00b110 months for major adverse cardiac events of death, death or myocardial infarction, and cardiac death or myocardial infarction. In the entire cohort, the 167 subjects (11%) with an abnormal scan experienced significantly higher rates of major adverse cardiac events and coronary revascularization than those with normal MPI. Among the 823 subjects (54.5%) whose MPIs were classified as appropriate (779, 51.6%) or uncertain (44, 2.9%), an abnormal scan predicted a multifold increase in the rates of death (9.2% versus 2.6%; hazard ratio, 3.1;\n              <jats:italic>P<\/jats:italic>\n              =0.004), death or myocardial infarction (11.8% versus 3.3%; hazard ratio, 3.3;\n              <jats:italic>P<\/jats:italic>\n              =0.001), cardiac death or myocardial infarction (6.7% versus 1.7%; hazard ratio, 3.7;\n              <jats:italic>P<\/jats:italic>\n              =0.006), and revascularization (24.7% versus 2.7%; hazard ratio, 11.4;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Among the 688 subjects (45.5%) with MPI classified as inappropriate, an abnormal MPI failed to predict major adverse cardiac events, although it was associated with a high revascularization rate. Furthermore, appropriate MPI use provided incremental prognostic value beyond myocardial perfusion and ejection fraction data.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>When performed for appropriate indications, SPECT-MPI continues to demonstrate high prognostic value. However, inappropriate use lacks effectiveness for risk stratification, further emphasizing the need for optimal patient selection for cardiac testing.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.113.002744","type":"journal-article","created":{"date-parts":[[2013,9,11]],"date-time":"2013-09-11T11:20:17Z","timestamp":1378898417000},"page":"1634-1643","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":122,"title":["Impact of Appropriate Use on the Prognostic Value of Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging"],"prefix":"10.1161","volume":"128","author":[{"given":"Rami","family":"Doukky","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Hayes","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Frogge","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkata Satish","family":"Dontaraju","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria O.","family":"Rangel","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmeen","family":"Golzar","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Garcia-Sayan","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Hendel","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Rush University Medical Center, Chicago, IL (R.D., K.H., N.F., M.O.R.); Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL (R.D., Y.G.); Department of Medicine, Iowa Methodist Medical Center, Des Moines (G.B.); Division of Hospitalist Medicine, Rockford Memorial Hospital, Rockford, IL (V.S.D.); Division of Cardiology, Mount Sinai Hospital, Chicago, IL (E.G.-S.); and Cardiovascular Division, University of Miami, Miller School of..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00177-6"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.12.041"},{"key":"e_1_3_4_4_2","first-page":"134","article-title":"Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients.","volume":"44","author":"Shaw LJ","year":"2003","unstructured":"Shaw LJ, Hendel R, Borges-Neto S, Lauer MS, Alazraki N, Burnette J, Krawczynska E, Cerqueira M, Maddahi J; Myoview Multicenter Registry. 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