Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT

J Nucl Cardiol. Jul-Aug 2000;7(4):333-41. doi: 10.1067/mnc.2000.105634.

Abstract

Background: The prognostic value of normal dual-isotope single photon emission computed tomography (SPECT), with technetium 99m-tetrofosmin for the stress images, is not well known. Furthermore, thallium-201 cross talk in the Tc-99m window may reduce the defect severity of the Tc-99m images.

Methods and results: In a consecutive series of 610 patients, 246 patients with normal rest and stress SPECT images by means of visual semiquantitative analysis were included. The patients' pre-test likelihood of coronary artery disease was determined, based on age, sex, symptoms, and the results of stress electrocardiography. Quality of life was assessed by using a mailed self-administered general quality-of-life questionnaire. We compared the mean scores (8 dimensions) of our study population with the scores of 1063 control subjects, sampled randomly out of the inhabitant register of a Dutch city. The mean follow-up period was 25+/-3 months. Compared with the control group, patients in our study scored lower (less perceived health) for all dimensions of the SF-36 (P<.05), suggesting a selection of symptomatic or otherwise diseased patients. The primary cardiac event rate was 0.4% per year. The cardiac events occurred in patients with an intermediate-to-high pre-test likelihood of disease and negative or nondiagnostic exercise electrocardiographic results. In a subset of patients with a high pre-test likelihood of coronary artery disease (more than 85%), the primary cardiac event rate was 0.7% per year.

Conclusions: Patients with normal results on dual-isotope myocardial perfusion scintigraphy, performed with Tc-99m-tetrofosmin for the stress images, have an excellent prognosis. Furthermore, our results suggest that Tl-201 cross talk in the Tc-99m window may be low and functionally and clinically unimportant.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Disease / diagnosis
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / mortality
  • Electrocardiography
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Organophosphorus Compounds*
  • Organotechnetium Compounds*
  • Prognosis
  • Quality of Life*
  • Radiopharmaceuticals*
  • Random Allocation
  • Surveys and Questionnaires
  • Survival Rate
  • Thallium Radioisotopes*
  • Tomography, Emission-Computed, Single-Photon*

Substances

  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • technetium tc-99m tetrofosmin