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Prognosis in patients achieving ≥10 METS on exercise stress testing: Was SPECT imaging useful?

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The benefit of myocardial perfusion imaging (MPI) over exercise ECG stress testing alone is unclear in individuals attaining a workload of ≥10 METS. The purpose of this prospective study is to determine mortality and nonfatal cardiac events in patients at either intermediate pretest risk for CAD or patients with known CAD, achieving ≥10 METS regardless of peak exercise heart rate. The authors previously reported a low prevalence of significant ischemia in this patient cohort.

Methods

Baseline characteristics, ECG stress test findings, and perfusion and function results from quantitative gated 99mTc-SPECT MPI were compared by achievement of a maximum age-predicted heart rate ≥85% in 509 consecutive patients who reached ≥10 METS. Events including all-cause and cardiac mortality, non-fatal myocardial infarction (MI), and late revascularization (>4 weeks after MPI) were prospectively collected.

Results

Of the 509 patients achieving ≥10 METS, follow-up for mortality was obtained in 463 (91%). Those lost to follow-up were older and had higher rates of tobacco use. The prevalences of CAD risk factors, prior known CAD, and MPI abnormalities were higher for the 68 patients failing to reach 85% of their target heart rate. The rate of ≥10% left-ventricular (LV) ischemia by MPI remained very low irrespective of attained heart rate (0.6% (3/463)). Six (1.2%) had an LVEF < 40%. Death occurred in 12 (2.6%) patients, one of which was classified as cardiac (0.1%/year). The other 11 deaths were related to cancer. Additionally, there were three nonfatal MIs (0.7 %) and one late revascularization (0.2%). Only one of these patients had any ischemia on MPI. No cardiac event patient had exercise ST depression or ≥5% LV ischemia.

Conclusions

Thus, patients at intermediate risk for CAD or known CAD achieving ≥10 METS have a very low prevalence of ≥10% LV ischemia and very low rates of cardiac mortality, nonfatal MI, and late revascularization, irrespective of heart rate achieved. Cardiac events did not correlate with abnormalities on the index MPI study. These results suggest that patients who attain ≥10 METS during exercise stress have an excellent prognosis over an intermediate term of follow-up, regardless of peak exercise heart rate achieved. The added value of MPI to standard exercise ECG testing in this population is questionable.

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Acknowledgment

The authors have indicated that they have no financial conflicts of interest.

Author information

Authors and Affiliations

  1. Cardiovascular Division and the Cardiovascular Imaging Center, Department of Medicine, University of Virginia Health System, P.O. Box 800158, 1215 Lee Street, Charlottesville, VA, 22908, USA

    Jamieson M. Bourque MD, MHS, George T. Charlton MD, Christopher M. Belyea BS & George A. Beller MD, MACC

  2. Division of Cardiology, Department of Medicine, Wake Forest University Medical Center, Winston-Salem, NC, USA

    Benjamin H. Holland MD

  3. Cardiovascular Imaging Center, Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA

    Jamieson M. Bourque MD, MHS & Denny D. Watson PhD

Authors
  1. Jamieson M. Bourque MD, MHS
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  2. George T. Charlton MD
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  3. Benjamin H. Holland MD
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  4. Christopher M. Belyea BS
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  5. Denny D. Watson PhD
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  6. George A. Beller MD, MACC
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Corresponding author

Correspondence to Jamieson M. Bourque MD, MHS.

Additional information

Dr Bourque is funded by an NIH NRSA Training Grant: T32 EB003841-04.

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Bourque, J.M., Charlton, G.T., Holland, B.H. et al. Prognosis in patients achieving ≥10 METS on exercise stress testing: Was SPECT imaging useful?. J. Nucl. Cardiol. 18, 230–237 (2011). https://doi.org/10.1007/s12350-010-9323-2

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  • DOI: https://doi.org/10.1007/s12350-010-9323-2

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