title: The prognostic value of vasodilator myocardial perfusion imaging in octogenarians.
abstract: The ability of single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to stratify risk in octogenarians is poorly defined. The authors identified 439 octogenarians who underwent vasodilator SPECT MPI between 1994 and 2000. Over a mean 2.5 years of follow-up, moderate and large stress defects were associated with increased crude mortality (normal: 24.5%, small defect: 21.9%, moderate or large stress defect: 41.4%, p for trend < 0.001). The degree of defect reversibility was also strongly associated with increased mortality (normal: 24.5%, no reversibility: 22.0%, small reversible defect: 36.5%, moderate or large reversible defect: 50.0%, p for trend < 0.001). In multivariable analysis, stress defects were the strongest predictor of mortality (hazard ratio, 2.39; 95% confidence interval, 1.56-3.65). The mortality of octogenarians with moderate or large perfusion defects is nearly double that of patients with normal or mildly abnormal MPI. Appropriately selected octogenarians with abnormal vasodilator SPECT imaging may benefit from more aggressive management of their cardiac disease.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8017, USA.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Frans J T
authors.initials: FJ
authors.lastname: Wackers
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
mesh_terms: D000241:Adenosine; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000401:mortality; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D004176:Dipyridamole; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012737:Sex Factors; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole; D000241:Adenosine