1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Prediction of 14-year cardiovascular outcomes by dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing
Stefan Roest1a,BSc; Hendrik J. Boiten1a,MD; Ron T. van Domburga,PhD; Roelf Valkemab,MD,PhD;Arend F.L. Schinkela, MD,PhD
1 Both authors contributed equally to this work.
aDepartment of Cardiology, bDepartment of Nuclear Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1. Dobutamine stress myocardial perfusion imaging (MPI) is a valuable alternative for the evaluation of coronary artery disease (CAD) in elderly patients
2. Data on the long-term prognostic value of stress MPI in these patients are lacking.
3. Therefore, this study evaluated the long-term prognostic value of dobutamine stress MPI in elderly patients unable to perform an exercise test.
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3. METHODS Study type: Retrospective observational cohort study
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type: Retrospective observational cohort study
Study subjects: 247 elderly patients ≥ 65 years old, unable to perform exercise testing, who underwent dobutamine stress 99mTc-tetrofosmin SPECT for the evaluation of suspected or known CAD.
Study endpoints: All-cause mortality, cardiac mortality and nonfatal myocardial infarction (MI) during long-term follow-up
Study variables: clinical data, abnormal stress SPECT, fixed/reversible defects, summed stress score (SSS).
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4. MPI = myocardial perfusion imaging.
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Figures. Kaplan-Meier survival curves for cardiac mortality (left) and cardiac mortality/nonfatal MI (right).
MPI = myocardial perfusion imaging.
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5. RESULTS Univariable and multivariable predictors of cardiac mortality
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS Univariable and multivariable predictors of cardiac mortality
Data are presented as hazard ratio (HR) and confidence interval (95%CI). MPI = myocardial perfusion imaging. MI = myocardial infarction. SSS* = summed stress score per % myocardium increment.
Variable
Univariable
Multivariable
Clinical data Model Model Model 3
Men
P=0.16
P=0.31 -
Prior MI
P=0.51
P=0.63
Diabetes mellitus
2.17 ( )
P=0.07
Hypertension
2.55 ( )
2.43 ( )
2.41 ( )
2.28 ( )
2.32 ( )
Hypercholesterolemia
P=0.47
P=0.60
Smoking
P=0.25
P=0.09
Heart failure
2.79 ( )
2.60 ( )
2.39 ( )
2.37 ( )
2.18 ( )
Stress test results
Angina pectoris
P=0.93
P=0.65
P=0.88
P=0.70
ST-segment changes
P=0.50
P=0.53
P=0.76
Peak heart rate
P=0.87
P=0.99
P=0.90
P=0.96
Scan parameters
Abnormal MPI
2.23 ( )
2.49 ( )
Fixed defect
P=0.34
P=0.17
Reversible defect
1.94 ( )
1.92 ( )
SSS*
1.11 ( )
1.09 ( )
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6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS Univariable and multivariable predictors of hard cardiac events
Data are presented as hazard ratio (HR) and confidence interval (95%CI). MPI = myocardial perfusion imaging. MI = myocardial infarction. SSS* = summed stress score per % myocardium increment.
Variable
Univariable
Multivariable
Clinical data Model Model Model 3
Men
1.70 ( )
P=0.07 -
Prior MI
P=0.73
P=0.83
Diabetes mellitus
1.76 ( )
P=0.19
Hypertension
2.31 ( )
2.24 ( )
2.16 ( )
2.02 ( )
2.00 ( )
Hypercholesterolemia
P=0.43
P=0.59
Smoking
P=0.28
P=0.14
Heart failure
2.24 ( )
2.11 ( )
1.90 ( )
1.90 ( )
P=0.05
Stress test results
Angina pectoris
P=0.77
P=0.47
P=0.65
P=0.54
ST-segment changes
P=0.48
P=0.31
P=0.91
P=0.95
Peak heart rate
P=0.41
P=0.44
P=0.34
Scan parameters
Abnormal MPI
2.32 ( )
2.72 ( )
Fixed defect
P=0.13
Reversible defect
1.79 ( )
1.85 ( )
SSS*
1.11 ( )
1.09 ( )
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7. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
Dobutamine-stress MPI provides incremental prognostic information for the prediction of all-cause mortality and cardiac events on the long-term outcome in elderly patients unable to perform exercise testing.
Information on the presence, severity, and extent of perfusion abnormalities can be used for risk stratification of this high-risk patient group.
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