Original Paper

The International Journal of Cardiovascular Imaging

, Volume 25, Issue 6, pp 569-579

First online:

Hemodynamic variables during stress testing can predict referral to early catheterization but failed to show a prognostic impact on emerging cardiac events in patients aged 70 years and older undergoing exercise 99mTc-sestamibi myocardial perfusion scintigraphy

  • Jan BuceriusAffiliated withDepartment of Nuclear Medicine, University of Bonn Email author 
  • , Alexius Y. JoeAffiliated withDepartment of Nuclear Medicine, University of Bonn
  • , Ellen HerderAffiliated withDepartment of Nuclear Medicine, University of Bonn
  • , Holger BrockmannAffiliated withDepartment of Nuclear Medicine, University of Bonn
  • , Kim BiermannAffiliated withDepartment of Nuclear Medicine, University of Bonn
  • , Holger PalmedoAffiliated withDepartment of Nuclear Medicine, University of Bonn
  • , Klaus TiemannAffiliated withDepartment of Internal Medicine II, University of Bonn
  • , Hans-Jürgen BiersackAffiliated withDepartment of Nuclear Medicine, University of Bonn

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Abstract

The aim of the present study was to evaluate the prognostic value of hemodynamic variables during ergometric stress testing for 99mTc-sestamibi myocardial perfusion scintigraphy (MPS) as compared to several patient-related variables and MPS results with regard to referral to early coronary angiography (<3 months after MPS; CA) as well as cardiac event (CE) free survival in a study population aged ≥70 years. About 90 patients aged ≥70 years (74.5 ± 3.6 years) who underwent ergometric stress/rest MPS were included in this study. About 19 hemodynamic variables during stress testing were assessed. Semiquantitative visual interpretation of MPS images were performed and Summed-Stress-(SSS), Summed-Difference-, and Summed-Rest-Scores were calculated. Emerging CE comprised myocardial revascularization and -infarction as well as cardiac-related death. Multivariate logistic regression analyses were performed for evaluation of independent prognostic impact of hemodynamic-, MPS- and clinical-variables with regard to referral to early catheterization as well as emerging CE. Kaplan–Meier survival- and log rank analyses were calculated for assessment of CE free survival. History of CAD (Odds ratio; OR: 99.3), low rest heart rate (OR: 14.9) and low peak systolic blood pressure (OR: 15.4) during ergometric stress testing as well as pathological SSS (OR: 48.4) were significantly associated with referral to CA. History of ischemic ECG (OR: 4.7) and pathological SSS (OR: 3.7) independently predicted emerging CE and were associated with a lower CE free survival. In patients aged ≥70 years, CA is independently predicted by clinical variables, pathological results of MPS and hemodynamic variables. In contrast, hemodynamic response to stress testing failed to show any predictive impact on emerging CE.

Keywords

Coronary artery disease Elderly 99mTc-sestamibi myocardial perfusion scintigraphy Hemodynamic variables Cardiac related outcome