title: Hemodynamic variables during stress testing can predict referral to early catheterization but failed to show a prognostic impact on emerging cardiac events in patients aged 70 years and older undergoing exercise (99m)Tc-sestamibi myocardial perfusion scintigraphy.
abstract: The aim of the present study was to evaluate the prognostic value of hemodynamic variables during ergometric stress testing for (99m)Tc-sestamibi myocardial perfusion scintigraphy (MPS) as compared to several patient-related variables and MPS results with regard to referral to early coronary angiography (<3 months after MPS; CA) as well as cardiac event (CE) free survival in a study population aged > or =70 years. About 90 patients aged > or =70 years (74.5 +/- 3.6 years) who underwent ergometric stress/rest MPS were included in this study. About 19 hemodynamic variables during stress testing were assessed. Semiquantitative visual interpretation of MPS images were performed and Summed-Stress-(SSS), Summed-Difference-, and Summed-Rest-Scores were calculated. Emerging CE comprised myocardial revascularization and -infarction as well as cardiac-related death. Multivariate logistic regression analyses were performed for evaluation of independent prognostic impact of hemodynamic-, MPS- and clinical-variables with regard to referral to early catheterization as well as emerging CE. Kaplan-Meier survival- and log rank analyses were calculated for assessment of CE free survival. History of CAD (Odds ratio; OR: 99.3), low rest heart rate (OR: 14.9) and low peak systolic blood pressure (OR: 15.4) during ergometric stress testing as well as pathological SSS (OR: 48.4) were significantly associated with referral to CA. History of ischemic ECG (OR: 4.7) and pathological SSS (OR: 3.7) independently predicted emerging CE and were associated with a lower CE free survival. In patients aged > or =70 years, CA is independently predicted by clinical variables, pathological results of MPS and hemodynamic variables. In contrast, hemodynamic response to stress testing failed to show any predictive impact on emerging CE.
authors.affiliation: Department of Nuclear Medicine, University of Bonn, Bonn, Germany. jan.bucerius@ukb.uni-bonn.de
authors.forename: Jan
authors.initials: J
authors.lastname: Bucerius
authors.forename: Alexius Y
authors.initials: AY
authors.lastname: Joe
authors.forename: Ellen
authors.initials: E
authors.lastname: Herder
authors.forename: Holger
authors.initials: H
authors.lastname: Brockmann
authors.forename: Kim
authors.initials: K
authors.lastname: Biermann
authors.forename: Holger
authors.initials: H
authors.lastname: Palmedo
authors.forename: Klaus
authors.initials: K
authors.lastname: Tiemann
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Biersack
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D017023:Coronary Angiography; D003326:Coronary Circulation; D018572:Disease-Free Survival; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi