Prediction of 14-year cardiovascular outcomes by dobutamine stress 99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing

J Nucl Cardiol. 2018 Feb;25(1):63-71. doi: 10.1007/s12350-016-0516-1. Epub 2016 Jul 5.

Abstract

Background: 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. 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.

Methods: The 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).

Results: During 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.

Conclusion: Dobutamine 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.

Keywords: 99mTc-tetrofosmin; coronary artery disease; dobutamine stress SPECT; elderly; long-term prognosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality
  • Disease Progression
  • Dobutamine
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Perfusion Imaging*
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Prognosis
  • Radiopharmaceuticals
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Tomography, Emission-Computed, Single-Photon*
  • Treatment Outcome

Substances

  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Dobutamine
  • technetium tc-99m tetrofosmin