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Pak J Nucl Med. 2017; 7(1): 28-33

Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy

Authors: Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi.

View PDF DOI: 10.24911/PJNMed.7.5

Abstract

Background: Cancer patients are at a higher risk for any cardiac event during and post surgery, due to an altered coagulation state and anemia, and can have additive effect if the patient had previous history of any cardiac event or risk factor for coronary artery disease such as hypertension and diabetes. Methods: 100 consecutive patients, who were being planned for the oncological surgery, were enrolled in this study for preoperative gated myocardial perfusion scintigraphy using99mTcsestamibi with adenosine stress. After acquiring the data, MPI were reconstructed and analyzed using visual assessment as well as QPS program and summed stress score (SSS) was obtained. Based on visual assessment and SSS, we divided patients into low- and high-risk groups. Results: 100 patients (57 female and 43 male) with a mean age 61.25 years. 63% had a history of diabetes,73% hypertension, 34% were known smokers while 42% had a family history of coronary artery disease and 15 patients has CAD. 61% fell into the low-risk group and 39%in the high-risk group. In the low-risk group 1 patient needed inotropic support post operatively while in high-risk group, 6 patients had cardiac events postoperatively. Subset analysis of these showed; 3 (7.69%) had an episode of angina prior to discharge, 2 died with cardiac-arrest due to myocardial infraction and 1 needed inotropic support postoperatively and surgery was deferred in 4 patients due to their very low LVEF and high SSS. These 4 patients were further evaluated by cardiologist for future management.Conclusion: In low-risk group patients, stress MPI has a high negative predictive value for peri- and post operative cardiac events in cancer patients. While patients with cancer and labeled as high-risk on myocardial perfusion imaging, whether demonstrating scar or ischemia, should prompt appropriate peri- and post operative management to minimize major cardiac events.

Keywords:   Myocardial perfusionscintigraphy, Pre-operative risk assessment,99mTc-sestamibi, Pharmacological stress,Adenosine, Coronary artery disease


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Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy


Authors
Iqbal Munir
Department of Nuclear Medicine, Al Takhassussi Hospital, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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Amrah Javaid
Department of Basic Health Sciences, College of Medicine, Princess Noura Binta Abdulrehman University for Women, Riyadh, Saudi Arabia
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Khalid Nawaz
Departemnt of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
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Mohammed Hathaf Al-Rowaily
Department of Chemistry, Pavia University, Italy
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Muaadh Abdualrehman Al-Asbahi
Department of Nuclear Medicine, Al Takhassussi Hospital, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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Correspondence to:
. Department of Nuclear Medicine, Al Takhassussi Hospital, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; Department of Basic Health Sciences, College of Medicine, Princess Noura Binta Abdulrehman University for Women, Riyadh, Saudi Arabia; Dep;

Publication history
Published in print 24 Jun 2018
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Pubmed Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pak J Nucl Med. 2017; 7(1): 28-33. doi:10.24911/PJNMed.7.5


Web Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. http://www.pjnmed.com/?mno=302235 [Access: April 10, 2020]. doi:10.24911/PJNMed.7.5


AMA (American Medical Association) Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pak J Nucl Med. 2017; 7(1): 28-33. doi:10.24911/PJNMed.7.5


Vancouver/ICMJE Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pak J Nucl Med. (2017), [cited April 10, 2020]; 7(1): 28-33. doi:10.24911/PJNMed.7.5


Harvard Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi (2017) Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pak J Nucl Med, 7 (1), 28-33. doi:10.24911/PJNMed.7.5


Turabian Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. 2017. Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pakistan Journal of Nuclear Medicine, 7 (1), 28-33. doi:10.24911/PJNMed.7.5


Chicago Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. "Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy." Pakistan Journal of Nuclear Medicine 7 (2017), 28-33. doi:10.24911/PJNMed.7.5


MLA (The Modern Language Association) Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi. "Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy." Pakistan Journal of Nuclear Medicine 7.1 (2017), 28-33. Print. doi:10.24911/PJNMed.7.5


APA (American Psychological Association) Style

Iqbal Munir, Amrah Javaid, Khalid Nawaz, Mohammed Hathaf Al-Rowaily, Muaadh Abdualrehman Al-Asbahi (2017) Pre-operative cardiac risk stratification for noncardiac surgery in cancer patients using myocardial perfusion scintigraphy. Pakistan Journal of Nuclear Medicine, 7 (1), 28-33. doi:10.24911/PJNMed.7.5


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