Prognostic assessment of uncomplicated first myocardial infarction by exercise echocardiography and Tc-99m tetrofosmin gated SPECT.
BACKGROUND
We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction.


RESULTS
We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P =.016) or by gated SPECT (OR 10.7, P =.009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P =.007) and greater than 15% ischemic extent in the polar map (OR 3.6, P =.04) of SPECT.


CONCLUSIONS
Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.
Candell-Riera
J
J
Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Llevadot
J
J
Santana
C
C
Castell
J
J
Aguadé
S
S
Armadans
L
L
Bermejo
B
B
Oller
G
G
García-del-Castillo
H
H
Soler-Peter
M
M
Soler-Soler
J
J
D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000209:etiology; D016017:Odds Ratio; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin