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Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study

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Abstract

Purpose

Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians.

Methods

Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% 201Tl, 22% 99mTc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Myocardial perfusion scoring was performed on a 17-segment LV-model with a 5-point grading system and three summed stress score (SSS)-based risk categories were formed [high-(SSS > 12), low-(SSS < 4), medium]. Prospective follow-up was performed to document all-cause (ACD), cardiac death (CD), MI, and revascularization. Revascularization was used to censor follow-up in survival analysis regarding ACD, CD, and CD/MI. For analysis of the CD, MI, or late revascularization (LR) composite, only revascularizations within 3 months from MPI (early revascularizations) were used for censoring.

Results

After 9.3 years there were 187 ACDs, 86 CDs, 28 MIs, and 77 revascularizations, including 28 early revascularizations. Adjusting for LVEF and stress-modality type, SSS was identified as an independent predictor of ACD [HR 1.03 (1.01–1.05)], CD [HR 1.05 (1.03–1.08)], CD,MI [HR 1.05 (1.02–1.07)], and CD,MI or LR [HR 1.05 (1.03–1.07)] (p ≤ 0.001 in all cases). Increased lung uptake had independent prognostic value only for the CD, MI, or LR end-point [HR 3 (1.2–7.7), p = 0.02]. Survival modeling demonstrated that LVEF and SSS, but not non-perfusion scintigraphic data provided incremental prognostic value over pre-test available clinical and historical information for all end-points. Differences between Kaplan-Meier survival curves of SSS-based risk groups were significant for all end-points (p < 0.001 in all cases).

Conclusions

In octogenarians, MPI provides effective long-term risk stratification, regardless of stress type used or underlying cardiac function.

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Abbreviations

CAD:

Coronary artery disease

MPI:

Myocardial perfusion imaging

SPECT:

Single photon emission computed tomography

ONERIS:

Onassis Cardiac Surgery Center Elderly Risk Stratification registry

ASNC:

American Society of Nuclear Cardiology

HR:

Heart rate

BP:

Blood pressure

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

SSS:

Summed stress score

SRS:

Summed rest score

SDS:

Summed difference score

TID:

Transient ischemic left ventricular dilation

LHR:

Lung to heart ratio

LV:

Left ventricular

ACD:

All-cause death

CD:

Cardiac death

ER:

Early revascularization

LR:

Late revascularization

LBBB:

Left bundle branch block

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Author information

Authors and Affiliations

  1. Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece

    Athanasios Katsikis, Athanasios Theodorakos, Vassiliki Manira & Maria Koutelou

  2. Cardiology Department, 401 General Military Hospital of Athens, Athens, Greece

    Athanasios Katsikis

  3. Zoodochou Pigis 54, Melissia, ZC 15127, Athens, Greece

    Athanasios Katsikis

  4. Cardiology Department, Athens Naval Hospital, Athens, Greece

    Spyridon Papaioannou

  5. Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece

    Genovefa Kolovou & Vassilios Voudris

Authors
  1. Athanasios Katsikis
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  2. Athanasios Theodorakos
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  3. Vassiliki Manira
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  4. Spyridon Papaioannou
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  5. Genovefa Kolovou
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Correspondence to Athanasios Katsikis.

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Funding

No funding sources to be disclosed for this study.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Katsikis, A., Theodorakos, A., Manira, V. et al. Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study. Eur J Nucl Med Mol Imaging 44, 1547–1558 (2017). https://doi.org/10.1007/s00259-017-3739-8

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  • DOI: https://doi.org/10.1007/s00259-017-3739-8

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