title: Simultaneous echocardiography and myocardial perfusion single photon emission computed tomography associated with dobutamine stress to predict long-term cardiac mortality in normotensive and hypertensive patients.
abstract: BACKGROUND
  Echocardiography and myocardial scintigraphy associated with dobutamine stress are used for assessing risk in coronary artery disease. We compared the accuracy of the two modalities applied simultaneously for predicting long-term cardiac mortality in normotensive and hypertensive patients.
  
  
  METHODS
  Three hundred and fifty-one consecutive patients underwent dobutamine stress with simultaneous echocardiography and Tc-sestamibi single photon emission computed tomography (SPECT). Fifty patients underwent early (<60 days) revascularization and were excluded; the analysis is based on 301 patients (131 hypertensives and 170 normotensives).
  
  
  RESULTS
  The prevalence of additional risk factors, heart failure, prior myocardial infarction and prior revascularization was similar in the two groups of patients. An abnormal stress echocardiogram was detected in 101 (59%) normotensives and 80 (61%) hypertensives (NS), while 113 (66%) normotensives and 83 (63%) hypertensives (NS) showed abnormal myocardial perfusion. The agreement was 81% (kappa = 0.59) in hypertensives and 82% (kappa = 0.62) in normotensives. During 7.3 +/- 2.8 years of follow-up, 17 (13%) hypertensives and 26 (15%) normotensives died from cardiac causes (P = 0.62). In normotensives, the annual mortality rate was 0.8 for normal echo and 1.3 for normal scan, 2.8 for abnormal echo and 2.6 for abnormal scan. In hypertensives, it was 0.5 for normal echo, 0% for normal scan, 2.6 for abnormal echo and 2.8 for abnormal scan. Each test was associated with higher survival in the case of negative compared to positive results in both normotensive and hypertensive patients (log-rank chi-square 16.4, P < 0.001).
  
  
  CONCLUSIONS
  Dobutamine stress echocardiography and SPECT are equally effective in predicting long-term cardiac death in both normotensive and hypertensive patients.
authors.affiliation: Department of Medicine and Surgery, University School of Medicine, Milan, Italy. Riccardo.Bigi@unimi.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Cesare
authors.initials: C
authors.lastname: Fiorentini
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi