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.
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.
Bigi
Riccardo
R
Department of Medicine and Surgery, University School of Medicine, Milan, Italy. Riccardo.Bigi@unimi.it
Bax
Jeroen J
JJ
van Domburg
Ron T
RT
Elhendy
Abdou
A
Cortigiani
Lauro
L
Schinkel
Arend F L
AF
Fiorentini
Cesare
C
Poldermans
Don
D
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
D017256:Technetium Tc 99m Sestamibi