Abstract

BackgroundDobutamine stress myocardial perfusion imaging (MPI) is a useful alternative for the evaluation of coronary artery disease (CAD) in elderly patients who are unable to perform an exercise stress test. However, data on the long-term prognostic value of stress MPI in elderly patients are lacking. Therefore, this study evaluated the long-term prognostic value of dobutamine stress MPI in elderly patients unable to perform an exercise test. MethodsThe study population consisted of 247 elderly patients (mean age 71 ± 5 years) who underwent dobutamine stress single-photon emission computed tomography (SPECT) MPI. An abnormal SPECT study was defined as the presence of fixed and/or reversible perfusion defects. A summed stress score (SSS) was obtained to estimate the extent and severity of perfusion defects. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI). ResultsDuring a median follow-up of 14 years (range 12-16), 168 (68%) patients died (all-cause mortality), of which 56 (23%) were due to cardiac causes. Nonfatal MI occurred in 19 (8%) patients. Kaplan-Meier survival curves showed that MPI provided optimal risk stratification in patients with normal and abnormal MPI. Multivariable analysis identified an abnormal MPI as a strong significant predictor of all-cause mortality and cardiac events. A multivariable analysis also revealed that a reversible defect and SSS were strong long-term predictors of cardiac mortality and hard cardiac events. ConclusionDobutamine stress 99mTc-tetrofosmin SPECT provides incremental prognostic information for the prediction of long-term cardiovascular outcomes in elderly patients, unable to perform exercise testing. Dobutamine stress MPI is useful in risk classifying elderly patients.

Highlights

  • Deaths from cardiovascular disease are increasing, in particular, due to the aging population

  • The current study is a continuation of a previous study 8 in which this population of elderly patients was evaluated with a mean follow-up of 3 years The reason to perform the current follow-up study was to assess the very long-term prognostic value of dobutamine stress single-photon emission computed tomography (SPECT)

  • The survival curves show that a normal myocardial perfusion imaging (MPI) was associated with relatively low risk of all-cause mortality, cardiac mortality, and hard cardiac events

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Summary

Introduction

Deaths from cardiovascular disease are increasing, in particular, due to the aging population. Stress myocardial perfusion imaging (MPI) is useful for the evaluation of coronary artery disease (CAD) in elderly patients.[2,3] A substantial proportion of the elderly population is unable to perform exercise stress testing, because of conditions such as degenerative joint disease or peripheral vascular disease. In such patients, vasodilator stress testing is a useful alternative. Dobutamine stress myocardial perfusion imaging (MPI) is a useful alternative for the evaluation of coronary artery disease (CAD) in elderly patients who are unable to perform an exercise stress test. 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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