title: Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests.
abstract: OBJECTIVE
  To compare the long-term prognostic value of dobutamine stress echocardiography and dobutamine stress single photon emission computed tomography (SPECT) in patients unable to perform an exercise test.
  
  
  METHODS
  We assessed the prognostic value of dobutamine stress technetium 99m ((99m)Tc)-sestamibi SPECT and dobutamine stress echocardiography in 301 patients who were unable to perform exercise tests. Outcomes during a mean (+/- SD) follow-up of 7.3 +/- 2.8 years were overall death, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization.
  
  
  RESULTS
  Abnormal myocardial perfusion was detected in 66% of patients (n = 198), while 60% (n = 182) had an abnormal stress echocardiogram; agreement was 82% (kappa = 0.62). During the follow-up period, 100 deaths (33%) occurred, of which 43% were due to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularization. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after a normal scan, and 2.6% for cardiac death and 6.5% for all cardiac events after an abnormal scan (P <0.0001). For stress echocardiography, annual event rates were 0.6% for cardiac death and 3.3% for all cardiac events after a normal test, and 2.8% for cardiac death and 6.9% for all cardiac events after an abnormal test (P <0.0001).
  
  
  CONCLUSIONS
  Dobutamine stress (99m)Tc-sestamibi SPECT and dobutamine stress echocardiography provide comparable long-term prognostic information in addition to that afforded by clinical data.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Eleni
authors.initials: E
authors.lastname: Vourvouri
authors.forename: Manolis
authors.initials: M
authors.lastname: Bountioukos
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Eric P
authors.initials: EP
authors.lastname: Krenning
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D019275:Radiopharmaceuticals; D016019:Survival Analysis; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi