ORIGINAL ARTICLE Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function Guillermo Romero-Farina & Jaume Candell-Riera & Santiago Aguadé-Bruix & Gemma Cuberas-Borrós & Ignacio Ferreira-González & María Nazarena Pizzi & Gustavo de León & Alba Santos & David García-Dorado Received: 17 February 2013 / Accepted: 18 April 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Background The objective of this study was to investigate the impact of clinical, electrocardiographic and stress testing variables in predicting hard cardiac events (HE) and coro- nary revascularization (CR) in patients with normal stress– rest gated SPECT. Materials and methods Included in the study were 2,004 patients (63.5±12.5 years, 41.6 % men) with normal myocar- dial perfusion and left ventricular ejection fraction (LVEF) >50 % on gated SPECT who were followed for HE (cardiovascular death or acute myocardial infarction) and CR. Results During a follow-up of 4.3±2.4 years, 33 patients (1.6 %; 0.4 %/year) had HE and 50 patients (2.5 %; 0.6 %/year) underwent CR. In a univariate analysis, age ≥65 years, insulin-dependent diabetes mellitus (IDDM), left bundle branch block (LBBB), and pharmacological stress were associated with HE. Independent predictors of HE were age ≥65 years (p <0.001; HR 6.9), IDDM (p =0.014; HR 3.4), and LBBB (p =0.002; HR 4.6). In the univariate analysis, male gender, LVEF, known coronary artery disease (CAD), LBBB, and a positive stress test were associated with CR. Independent predictors of CR were known CAD (p =0.016; HR 2.1), and a positive stress test (p =0.006; HR 2.3). Conclusion Age ≥65 years, IDDM, and LBBB are HE- independent predictors in patients with normal myocardial perfusion and normal LVEF on gated SPECT. The presence of known CAD or a positive stress test significantly in- creases the probability of CR during follow-up. Keywords Normal gated SPECT . Hard events . Coronary revascularization . Diabetes mellitus . Left bundle branch block . Stress test Introduction Single photon emission CT (SPECT) myocardial perfusion imaging has an important role in the diagnosis and risk stratification of patients with coronary artery disease (CAD). There are a number of reports [1–20] of the excel- lent short-term prognosis in patients with normal SPECT, even in those with a high pretest likelihood of CAD. Patients with normal myocardial perfusion SPECT are considered to be at low risk of cardiac events: the annualized event rate is generally <1 % during the first year after testing. Several studies have also shown that CAD [3], type of stress test [8], number of cardiovascular risk factors [13], and exercise capacity [20] are important predictors of hard cardiac events (HE), but in these series the role of normal gated SPECT (normal perfusion plus normal left ventricular G. Romero-Farina : J. Candell-Riera : G. Cuberas-Borrós : I. Ferreira-González : M. Nazarena Pizzi : G. de León : A. Santos : D. García-Dorado Cardiology Department, Hospital Universitari Vall d’Hebron. Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain S. Aguadé-Bruix Department of Nuclear Medicine, Hospital Universitari Vall d’Hebron. Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain G. Romero-Farina (*) Servei de Cardiologia, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain e-mail: guirom@adinet.com.uy G. Romero-Farina e-mail: guirom@telefonica.net Eur J Nucl Med Mol Imaging DOI 10.1007/s00259-013-2438-3