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Myocardial Perfusion Imaging for Risk Stratification in Asymptomatic Individuals Without Known Cardiovascular Disease

  • Cardiac Nuclear Imaging (A Cuocolo, Section Editor)
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Abstract

Coronary atherosclerosis is a chronic process starting already in teenage years and progressing over years often silently. Once perfusion abnormalities are diagnosed the disease process already has an advanced state. Myocardial infarctions are often due to nonobstructive ruptured plaques and not to high grade stenosis. Therefore risk stratification in an individualized tailored approach is warranted. Routine myocardial perfusion scintigraphy (MPS) is currently not recommended in the general asymptomatic population with low or intermediate cardiovascular risk. Nevertheless high rates of silent ischemia are found in selected patient groups, particularly in asymptomatic diabetic patients. For this reason in carefully selected patients with diabetes, PAVD, chronic kidney disease, or individuals prior to major surgery functional assessment with MPS allows identification of high risk patients and can provide prognostic information and possibly improve outcome. In individuals with positive family history of coronary artery disease anatomical screening with coronary calcium score and computed tomography angiography allows to identify individuals at risk for ischemic events. In this review incidence/prevalence of silent coronary artery disease are summarized, with a focus on patient screening with myocardial perfusion imaging. Possible strategies are provided for decision making in a clinical context.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rose G. Strategy of prevention: lessons from cardiovascular disease. BMJ. 1981;282:1847–51.

    Article  CAS  PubMed  Google Scholar 

  2. D'Agostino Sr RB, Grundy S, Sullivan LM, Wilson P, Group CHDRP. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286:180–7.

    Article  PubMed  Google Scholar 

  3. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation. 2002;105:310–5.

    Article  PubMed  Google Scholar 

  4. Shaw LJ, Iskandrian AE. Prognostic value of gated myocardial perfusion SPECT. J Nucl Cardiol. 2004;11:171–85. doi:10.1016/j.nuclcard.2003.12.004.

    Article  PubMed  Google Scholar 

  5. Perrone-Filardi P, Costanzo P, Dellegrottaglie S, Gargiulo P, Ruggiero D, Savarese G, et al. Prognostic role of myocardial single photon emission computed tomography in the elderly. J Nucl Cardiol. 2010;17:310–5. doi:10.1007/s12350-009-9182-x. This paper summarizes the evaluation of elderly patients with respect to coronary artery disease.

    Article  PubMed  Google Scholar 

  6. Fleg JL, Gerstenblith G, Zonderman AB, Becker LC, Weisfeldt ML, Costa Jr PT, et al. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation. 1990;81:428–36.

    Article  CAS  PubMed  Google Scholar 

  7. Khandaker MH, Miller TD, Chareonthaitawee P, Askew JW, Hodge DO, Gibbons RJ. Stress single photon emission computed tomography for detection of coronary artery disease and risk stratification of asymptomatic patients at moderate risk. J Nucl Cardiol. 2009;16:516–23. doi:10.1007/s12350-009-9085-x.

    Article  PubMed  Google Scholar 

  8. Wang L, Jerosch-Herold M, Jacobs Jr DR, Shahar E, Detrano R, Folsom AR, et al. Coronary artery calcification and myocardial perfusion in asymptomatic adults: the MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2006;48:1018–26. doi:10.1016/j.jacc.2006.04.089.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–e164. doi:10.1016/j.jacc.2012.07.013. These American guidelines provide important information regarding the evaluation of stable coronary artery disease.

    Article  PubMed  Google Scholar 

  10. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Task Force M, et al. ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003. doi:10.1093/eurheartj/eht296. These European guidelines regarding stable coronary artery disease stress the importance of risk stratification in patients with suspected or diagnosed coronary artery disease. Furthermore, they underline the importance of cardiac imaging as compared with a nonimaging stress test.

    Article  PubMed  Google Scholar 

  11. Zellweger MJ, Hachamovitch R, Kang X, Hayes SW, Friedman JD, Germano G, et al. Threshold, incidence, and predictors of prognostically high-risk silent ischemia in asymptomatic patients without prior diagnosis of coronary artery disease. J Nucl Cardiol. 2009;16:193–200. doi:10.1007/s12350-008-9016-2.

    Article  PubMed  Google Scholar 

  12. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122:e584–636. doi:10.1161/CIR.0b013e3182051b4c.

    Article  PubMed  Google Scholar 

  13. Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. 2010;56:1397–406. doi:10.1016/j.jacc.2010.06.030.

    Article  PubMed  Google Scholar 

  14. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–34. doi:10.1056/NEJM199807233390404.

    Article  CAS  PubMed  Google Scholar 

  15. Goraya TY, Leibson CL, Palumbo PJ, Weston SA, Killian JM, Pfeifer EA, et al. Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study. J Am Coll Cardiol. 2002;40:946–53.

    Article  PubMed  Google Scholar 

  16. Nesto RW, Phillips RT, Kett KG, Hill T, Perper E, Young E, et al. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy. Ann Int Med. 1988;108:170–5.

    Article  CAS  PubMed  Google Scholar 

  17. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434–44.

    Article  CAS  PubMed  Google Scholar 

  18. Arenja N, Mueller C, Ehl NF, Brinkert M, Roost K, Reichlin T, et al. Prevalence, extent, and independent predictors of silent myocardial infarction. Am J Med. 2013;126:515–22. doi:10.1016/j.amjmed.2012.11.028. Unrecognized myocardial infarctions are more common in diabetic than nondiabetic patients.

    Article  PubMed  Google Scholar 

  19. Ehl NF, Kuhne M, Brinkert M, Muller-Brand J, Zellweger MJ. Diabetes reduces left ventricular ejection fraction–irrespective of presence and extent of coronary artery disease. Eur J Endocrinol. 2011;165:945–51. doi:10.1530/EJE-11-0687. Left ventricular ejection fraction is lower in diabetic than in nondiabetic patients, irrespective of the presence and extent of coronary artery disease.

    Article  CAS  PubMed  Google Scholar 

  20. Kwong RY, Sattar H, Wu H, Vorobiof G, Gandla V, Steel K, et al. Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction. Circulation. 2008;118:1011–20. doi:10.1161/CIRCULATIONAHA.107.727826.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Miller TD, Rajagopalan N, Hodge DO, Frye RL, Gibbons RJ. Yield of stress single-photon emission computed tomography in asymptomatic patients with diabetes. Am Heart J. 2004;147:890–6. doi:10.1016/j.ahj.2003.08.015.

    Article  PubMed  Google Scholar 

  22. Zellweger MJ, Hachamovitch R, Kang X, Hayes SW, Friedman JD, Germano G, et al. Prognostic relevance of symptoms vs objective evidence of coronary artery disease in diabetic patients. Eur Heart J. 2004;25:543–50. doi:10.1016/j.ehj.2004.02.013.

    Article  PubMed  Google Scholar 

  23. Janand-Delenne B, Savin B, Habib G, Bory M, Vague P, Lassmann-Vague V. Silent myocardial ischemia in patients with diabetes: who to screen. Diabetes Care. 1999;22:1396–400.

    Article  CAS  PubMed  Google Scholar 

  24. Nesto RW, Phillips RT. Silent myocardial ischemia: clinical characteristics, underlying mechanisms, and implications for treatment. Am J Med. 1986;81:12–9.

    Article  CAS  PubMed  Google Scholar 

  25. Rutter MK, Wahid ST, McComb JM, Marshall SM. Significance of silent ischemia and microalbuminuria in predicting coronary events in asymptomatic patients with type 2 diabetes. J Am Coll Cardiol. 2002;40:56–61.

    Article  CAS  PubMed  Google Scholar 

  26. Langer A, Freeman MR, Josse RG, Steiner G, Armstrong PW. Detection of silent myocardial ischemia in diabetes mellitus. Am J Cardiol. 1991;67:1073–8.

    Article  CAS  PubMed  Google Scholar 

  27. Rutter MK, McComb JM, Brady S, Marshall SM. Silent myocardial ischemia and microalbuminuria in asymptomatic subjects with noninsulin-dependent diabetes mellitus. Am J Cardiol. 1999;83:27–31.

    Article  CAS  PubMed  Google Scholar 

  28. Murray DP, O'Brien T, Mulrooney R, O'Sullivan DJ. Autonomic dysfunction and silent myocardial ischaemia on exercise testing in diabetes mellitus. Diabet Med. 1990;7:580–4.

    Article  CAS  PubMed  Google Scholar 

  29. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D, et al. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation. 2004;110:22–6. doi:10.1161/01.CIR.0000133278.81226.C9.

    Article  PubMed  Google Scholar 

  30. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA. 1999;281:1291–7.

    Article  CAS  PubMed  Google Scholar 

  31. Bax JJ, Bonow RO, Tschope D, Inzucchi SE, Barrett E, Global Dialogue Group for the Evaluation of Cardiovascular Risk in Patients With D. The potential of myocardial perfusion scintigraphy for risk stratification of asymptomatic patients with type 2 diabetes. J Am Coll Cardiol. 2006;48:754–60.

    Article  PubMed  Google Scholar 

  32. Lacourciere Y, Cote C, Lefebvre J, Dumont M. Noninvasive detection of silent coronary artery disease in patients with essential hypertension, alone or associated with type 2 diabetes mellitus, using dipyridamole stress 99mtechnetium-sestamibi myocardial perfusion imaging. Can J Cardiol. 2006;22(Suppl A):16A–21A.

    PubMed  Google Scholar 

  33. Nakajima K, Yamasaki Y, Kusuoka H, Izumi T, Kashiwagi A, Kawamori R, et al. Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2009;36:2049–57. doi:10.1007/s00259-009-1207-9.

    Article  PubMed  Google Scholar 

  34. Scholte AJ, Schuijf JD, Kharagjitsingh AV, Dibbets-Schneider P, Stokkel MP, van der Wall EE, et al. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus. Eur J Nucl Med Mol Imaging. 2009;36:567–75. doi:10.1007/s00259-008-0967-y.

    Article  CAS  PubMed  Google Scholar 

  35. Valensi P, Paries J, Brulport-Cerisier V, Torremocha F, Sachs RN, Vanzetto G, et al. Predictive value of silent myocardial ischemia for cardiac events in diabetic patients: influence of age in a French multicenter study. Diabetes Care. 2005;28:2722–7.

    Article  PubMed  Google Scholar 

  36. Young LH, Wackers FJ, Chyun DA, Davey JA, Barrett EJ, Taillefer R, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301:1547–55. doi:10.1001/jama.2009.476.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ, et al. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27:1954–61.

    Article  PubMed  Google Scholar 

  38. Raggi P, Shaw LJ, Berman DS, Callister TQ. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol. 2004;43:1663–9. doi:10.1016/j.jacc.2003.09.068.

    Article  CAS  PubMed  Google Scholar 

  39. Elkeles RS, Godsland IF, Feher MD, Rubens MB, Roughton M, Nugara F, et al. Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J. 2008;29:2244–51. doi:10.1093/eurheartj/ehn279.

    Article  CAS  PubMed  Google Scholar 

  40. Anand DV, Lim E, Lahiri A, Bax JJ. The role of noninvasive imaging in the risk stratification of asymptomatic diabetic subjects. Eur Heart J. 2006;27:905–12. doi:10.1093/eurheartj/ehi441.

    Article  PubMed  Google Scholar 

  41. Scholte AJ, Bax JJ, Wackers FJ. Screening of asymptomatic patients with type 2 diabetes mellitus for silent coronary artery disease: combined use of stress myocardial perfusion imaging and coronary calcium scoring. J Nucl Cardiol. 2006;13:11–8. doi:10.1016/j.nuclcard.2005.11.002.

    Article  PubMed  Google Scholar 

  42. Friedlander Y, Siscovick DS, Weinmann S, Austin MA, Psaty BM, Lemaitre RN, et al. Family history as a risk factor for primary cardiac arrest. Circulation. 1998;97:155–60.

    Article  CAS  PubMed  Google Scholar 

  43. Leander K, Hallqvist J, Reuterwall C, Ahlbom A, de Faire U. Family history of coronary heart disease, a strong risk factor for myocardial infarction interacting with other cardiovascular risk factors: results from the Stockholm Heart Epidemiology Program (SHEEP). Epidemiology. 2001;12:215–21.

    Article  CAS  PubMed  Google Scholar 

  44. Pohjola-Sintonen S, Rissanen A, Liskola P, Luomanmaki K. Family history as a risk factor of coronary heart disease in patients under 60 years of age. Eur Heart J. 1998;19:235–9.

    Article  CAS  PubMed  Google Scholar 

  45. Roncaglioni MC, Santoro L, D'Avanzo B, Negri E, Nobili A, Ledda A, et al. Role of family history in patients with myocardial infarction. An Italian case-control study. GISSI-EFRIM Investigators. Circulation. 1992;85:2065–72.

    Article  CAS  PubMed  Google Scholar 

  46. Shea S, Ottman R, Gabrieli C, Stein Z, Nichols A. Family history as an independent risk factor for coronary artery disease. J Am Coll Cardiol. 1984;4:793–801.

    Article  CAS  PubMed  Google Scholar 

  47. Sesso HD, Lee IM, Gaziano JM, Rexrode KM, Glynn RJ, Buring JE. Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women. Circulation. 2001;104:393–8.

    Article  CAS  PubMed  Google Scholar 

  48. Lloyd-Jones DM, Nam BH, D'Agostino Sr RB, Levy D, Murabito JM, Wang TJ, et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. JAMA. 2004;291:2204–11. doi:10.1001/jama.291.18.2204.

    Article  CAS  PubMed  Google Scholar 

  49. Horne BD, Camp NJ, Muhlestein JB, Cannon-Albright LA. Identification of excess clustering of coronary heart diseases among extended pedigrees in a genealogical population database. Am Heart J. 2006;152:305–11. doi:10.1016/j.ahj.2005.12.028.

    Article  PubMed  Google Scholar 

  50. Hunt SC, Williams RR, Barlow GK. A comparison of positive family history definitions for defining risk of future disease. J Chron Dis. 1986;39:809–21.

    Article  CAS  PubMed  Google Scholar 

  51. Hirose K, Chikamori T, Hida S, Tanaka H, Igarashi Y, Watanabe Y, et al. Prevalence of coronary heart disease in patients with aortic aneurysm and/or peripheral artery disease. Am J Cardiol. 2009;103:1215–20. doi:10.1016/j.amjcard.2009.01.033.

    Article  PubMed  Google Scholar 

  52. Aronow WS, Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women> or = 62 years of age. Am J Cardiol. 1994;74:64–5.

    Article  CAS  PubMed  Google Scholar 

  53. Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381–6. doi:10.1056/NEJM199202063260605.

    Article  CAS  PubMed  Google Scholar 

  54. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss LK, et al. 2011 ACCF/AHA Focused update of the Guidelines for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58:2020–45. doi:10.1016/j.jacc.2011.08.023.

    Article  PubMed  Google Scholar 

  55. Dahan M, Viron BM, Faraggi M, Himbert DL, Lagallicier BJ, Kolta AM, et al. Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney Int. 1998;54:255–62. doi:10.1046/j.1523-1755.1998.00988.x.

    Article  CAS  PubMed  Google Scholar 

  56. Brown JH, Vites NP, Testa HJ, Prescott MC, Hunt LP, Gokal R, et al. Value of thallium myocardial imaging in the prediction of future cardiovascular events in patients with end-stage renal failure. Nephrol Dial Transplant. 1993;8:433–7.

    CAS  PubMed  Google Scholar 

  57. Dussol B, Bonnet JL, Sampol J, Savin B, De La Forte C, Mundler O, et al. Prognostic value of inducible myocardial ischemia in predicting cardiovascular events after renal transplantation. Kidney Int. 2004;66:1633–9. doi:10.1111/j.1523-1755.2004.00929.x.

    Article  PubMed  Google Scholar 

  58. Momose M, Babazono T, Kondo C, Kobayashi H, Nakajima T, Kusakabe K. Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis. Eur J Nucl Med Mol Imaging. 2009;36:1315–21. doi:10.1007/s00259-009-1110-4.

    Article  PubMed  Google Scholar 

  59. Kim SB, Lee SK, Park JS, Moon DH. Prevalence of coronary artery disease using thallium-201 single photon emission computed tomography among patients newly undergoing chronic peritoneal dialysis and its association with mortality. Am J Nephrol. 2004;24:448–52. doi:10.1159/000080220.

    Article  PubMed  Google Scholar 

  60. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305. doi:10.1056/NEJMoa041031.

    Article  CAS  PubMed  Google Scholar 

  61. Boucher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med. 1985;312:389–94. doi:10.1056/NEJM198502143120701.

    Article  CAS  PubMed  Google Scholar 

  62. Cutler BS, Leppo JA. Dipyridamole thallium 201 scintigraphy to detect coronary artery disease before abdominal aortic surgery. J Vasc Surg. 1987;5:91–100.

    CAS  PubMed  Google Scholar 

  63. American College of Cardiology Foundation/American Heart Association Task Force on Practice G, American Society of E, American Society of Nuclear C, Heart Rhythm S, Society of Cardiovascular A, Society for Cardiovascular A et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2009;54:e13–e118. doi:10.1016/j.jacc.2009.07.010.

    Article  Google Scholar 

  64. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery–Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2002;94:1052–64.

    Article  PubMed  Google Scholar 

  65. Shaw LJ, Eagle KA, Gersh BJ, Miller DD. Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. J Am Coll Cardiol. 1996;27:787–98.

    Article  CAS  PubMed  Google Scholar 

  66. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  PubMed  Google Scholar 

  67. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2009;120:e169–276. doi:10.1161/CIRCULATIONAHA.109.192690.

    Article  PubMed  Google Scholar 

  68. Poldermans D, Bax JJ, Boersma E, et al. Task Force for Preoperative Cardiac Risk A, Perioperative Cardiac Management in Non-cardiac S, European Society of C. Guidelines for Pre-Operative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-Cardiac Surgery. Eur Heart J. 2009;30:2769–812. doi:10.1093/eurheartj/ehp337.

    Article  PubMed  Google Scholar 

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Miriam Brinkert declares that she has no conflict of interest. Michael J. Zellweger declares that he has no conflict of interest.

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  1. Cardiology Department, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Miriam Brinkert & Michael J. Zellweger

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Brinkert, M., Zellweger, M.J. Myocardial Perfusion Imaging for Risk Stratification in Asymptomatic Individuals Without Known Cardiovascular Disease. Curr Cardiovasc Imaging Rep 7, 9253 (2014). https://doi.org/10.1007/s12410-013-9253-x

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