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Background: Phase analysis of single-photon emission computed tomography myocardial perfusion imaging provides dyssynchrony information which correlates well with assessments by echocardiography, but the independent prognostic significance is not well defined. This study assessed the independent prognostic value of single-photon emission computed tomography-myocardial perfusion imaging phase analysis in the largest multinational registry to date across all modalities., Methods: From the REFINE SPECT (Registry of Fast Myocardial Perfusion Imaging With Next Generation SPECT), a total of 19 210 patients were included (mean age 63.8±12.0 years and 56% males). Poststress total perfusion deficit, left ventricular ejection fraction, and phase variables (phase entropy, bandwidth, and SD) were obtained automatically. Cox proportional hazards analyses were performed to assess associations with major adverse cardiac events (MACE)., Results: During a follow-up of 4.5±1.7 years, 2673 (13.9%) patients experienced MACE. Annualized MACE rates increased with phase variables and were ≈4-fold higher between the second and highest decile group for entropy (1.7% versus 6.7%). Optimal phase variable cutoff values stratified MACE risk in patients with normal and abnormal total perfusion deficit and left ventricular ejection fraction. Only entropy was independently associated with MACE. The addition of phase entropy significantly improved the discriminatory power for MACE prediction when added to the model with total perfusion deficit and left ventricular ejection fraction ( P <0.0001)., Conclusions: In a largest to date imaging study, widely representative, international cohort, phase variables were independently associated with MACE and improved risk stratification for MACE beyond the prediction by perfusion and left ventricular ejection fraction assessment alone. Phase analysis can be obtained fully automatically, without additional radiation exposure or cost to improve MACE risk prediction and, therefore, should be routinely reported for single-photon emission computed tomography-myocardial perfusion imaging studies.

We report the clinical and laboratory characteristics of measles infection in an unselected group of 461 young adults. Otitis media was diagnosed in 9.8%, sinusitis in 4.1%, pneumonia in 3.7%, and keratitis in 3.3% of the patients. Minor T-wave changes on electrocardiogram were observed in only 0.7% and jaundice in 0.4%. Elevated liver enzymes were found in 51% of the patients. Creatine kinase (CK) MM fraction was high in 44%. Traces of myoglobin were found in the urine of 14% of those with a high CK, and of the 13 patients with the higher CKs, 12 had an abnormal serum aldolase. We emphasize several points of interest in this large and unselected group of young adults. There was 1) possible evidence of rhabdomyolisis in some of our patients; 2) a lower rate of electrocardiogram abnormalities than previously reported; 3) no evident correlation between initial laboratory values and subsequent complications; and 4) lack of a clinical or laboratory difference between patients who had been vaccinated with an attenuated virus during childhood and those who had not.