Advertisement

Journal of Nuclear Cardiology

, Volume 17, Issue 4, pp 617–624 | Cite as

Blunted heart rate response as a predictor of cardiac death in patients undergoing vasodilator stress technetium-99m sestamibi gated SPECT myocardial perfusion imaging

  • Shishir Mathur
  • Anuj R. Shah
  • Alan W. Ahlberg
  • Deborah M. Katten
  • Gary V. Heller
Original Article

Abstract

Introduction

The prognostic value of a blunted heart rate response (BHR) during ECG-gated vasodilator stress SPECT MPI in relation to ventricular function on long-term cardiovascular events is not well established. We performed this study to evaluate the incremental prognostic value of BHR during pharmacological stress SPECT MPI.

Methods

Consecutive patients who underwent dipyridamole stress Tc-99m sestamibi ECG-gated SPECT MPI (without exercise) were identified. The ratio of peak stress heart rate to baseline was noted. If the ratio was <1.20, it was considered blunted (BHR). The images were interpreted using the standard ASNC 17 segment model. Patients were followed up for a mean time period of 2.3 ± 1.5 years.

Results

Sixty-four percent (2,890/4,484) of patients demonstrated BHR during dipyridamole stress testing. Cardiac death, the primary end point, occurred in 6.8% of patients. Patients with BHR had a significantly lower cardiac death-free survival as compared to NO BHR group in total population (83% vs 94%; P < .001) as well as in subgroup with normal ejection fraction (89% vs 96%; P < .001). BHR was an independent predictor of cardiac death after adjusting for multiple clinical, perfusion, and function-related gated SPECT variables.

Conclusion

Blunted heart rate response during vasodilator stress SPECT MPI is an important prognostic marker for cardiac death.

Keywords

Dipyridamole pharmacologic stress vasodilator stress myocardial perfusion imaging SPECT technetium-99m 

References

  1. 1.
    Hinkle LE Jr, Carver ST, Plakun A. Slow heart rates and increased risk of cardiac death in middle-aged men. Arch Intern Med 1972;129:732-48.CrossRefPubMedGoogle Scholar
  2. 2.
    Ellestad MH, Wan MK. Predictive implications of stress testing: Follow-up of 2700 subjects after maximum treadmill stress testing. Circulation 1975;51:363-9.PubMedGoogle Scholar
  3. 3.
    Lauer MS, Okin PM, Larson MG, Evans JC, Levy D. Impaired heart rate response to graded exercise: Prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation 1996;93:1520-6.PubMedGoogle Scholar
  4. 4.
    Sandvik L, Erikssen J, Ellestad M. Heart rate increase and maximal heart rate during exercise as predictors of cardiovascular mortality: A 16-year follow-up study of 1960 healthy men. Coron Artery Dis 1995;6:667-79.CrossRefPubMedGoogle Scholar
  5. 5.
    Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA 1999;281:524-9.CrossRefPubMedGoogle Scholar
  6. 6.
    Abidov A, Hachamovitch R, Hayes SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study. Circulation 2003;107:2894-9.CrossRefPubMedGoogle Scholar
  7. 7.
    Bhatheja R, Francis GS, Pothier CE, Lauer MS. Heart rate response during dipyridamole stress as a predictor of mortality in patients with normal myocardial perfusion and normal electrocardiograms. Am J Cardiol 2005;95(10):1159-64.CrossRefPubMedGoogle Scholar
  8. 8.
    American Society of Nuclear Cardiology. Imaging guidelines for nuclear cardiology procedures, part 2. J Nucl Cardiol 1999;6:G47-84.CrossRefGoogle Scholar
  9. 9.
    Cerqueria MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.CrossRefGoogle Scholar
  10. 10.
    Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36(11):2138-47.PubMedGoogle Scholar
  11. 11.
    Sharir T, Germano G, Kang X, Lewin HC, Miranda R, Cohen I, et al. Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: Risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. J Nucl Med 2001;42:831-7.PubMedGoogle Scholar
  12. 12.
    Travin MI, Heller GV, Johnson LL, Katten D, Ahlberg AW, Isasi CR, et al. The prognostic value of ECG-gated SPECT imaging in patients undergoing stress Tc-99m sestamibi myocardial perfusion imaging. J Nucl Cardiol 2004;11:253-62.CrossRefPubMedGoogle Scholar
  13. 13.
    Barron HV, Lesh MD. Autonomic nervous system and sudden cardiac death. J Am Coll Cardiol 1996;27:1053-60.CrossRefPubMedGoogle Scholar
  14. 14.
    Fauchier L, Babuty D, Cosnay P, Autret ML, Fauchier JP. Heart rate variability in idiopathic dilated cardiomyopathy: Characteristics and prognostic value. J Am Coll Cardiol 1997;30:1009-14.CrossRefPubMedGoogle Scholar
  15. 15.
    Stein PK, Barzilay JI, Chaves PH, Mistretta SQ, Domitrovich PP, Gottdiener JS, et al. Novel measures of heart rate variability predict cardiovascular mortality in older adults independent of traditional cardiovascular risk factors: The Cardiovascular Health Study (CHS). J Cardiovasc Electrophysiol 2008;19:1169-74.CrossRefPubMedGoogle Scholar
  16. 16.
    Hage FG, Perry G, Heo J, Iskandrian AE. Blunting of the heart rate response to adenosine and regadenoson in relation to hyperglycemia and the metabolic syndrome. Am J Cardiol 2010;105:839-43.CrossRefPubMedGoogle Scholar
  17. 17.
    Chin CF, Messenger JC, Greenberg PS, Ellestad MH. Chronotropic incompetence in exercise testing. Clin Cardiol 1979;2:12-8.PubMedGoogle Scholar
  18. 18.
    Dresing TJ, Blackstone EH, Pashkow FJ, Snader CE, Marwick TH, Lauer MS. Usefulness of impaired chronotropic response to exercise as a predictor of mortality, independent of the severity of coronary artery disease. Am J Cardiol 2000;86:602-9.CrossRefPubMedGoogle Scholar
  19. 19.
    Myers J, Tan SY, Abella J, Aleti V, Froelicher VF. Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil 2007;14:215-21.CrossRefPubMedGoogle Scholar
  20. 20.
    Venkataraman R, Hage FG, Dorfman TA, Heo J, Aqel RA, de Mattos AM, et al. Relation between heart rate response to adenosine and mortality in patients with end-stage renal disease. Am J Cardiol 2009;103(8):1159-64.CrossRefPubMedGoogle Scholar
  21. 21.
    De Lorenzo A, Lima RS. Influence of chronic renal failure on the heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT. J Nucl Cardiol 2008;15:193-200.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2010

Authors and Affiliations

  • Shishir Mathur
    • 1
  • Anuj R. Shah
    • 1
  • Alan W. Ahlberg
    • 1
  • Deborah M. Katten
    • 1
  • Gary V. Heller
    • 1
  1. 1.Nuclear Cardiology Laboratory, Henry Low Heart CenterHartford HospitalHartfordUSA

Personalised recommendations