title: Prediction of 14-year cardiovascular outcomes by dobutamine stress99mTc-tetrofosmin myocardial perfusion SPECT in elderly patients unable to perform exercise testing.
abstract: Dobutamine stress myocardial perfusion imaging (MPI) is a useful alternative for the evaluation of coronary artery disease (CAD) in elderly patients who are unable to perform an exercise stress test. However, data on the long-term prognostic value of stress MPI in elderly patients are lacking. Therefore, this study evaluated the long-term prognostic value of dobutamine stress MPI in elderly patients unable to perform an exercise test.
  
  
  
  The study population consisted of 247 elderly patients (mean age 71 ± 5 years) who underwent dobutamine stress single-photon emission computed tomography (SPECT) MPI. An abnormal SPECT study was defined as the presence of fixed and/or reversible perfusion defects. A summed stress score (SSS) was obtained to estimate the extent and severity of perfusion defects. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI).
  
  
  
  During a median follow-up of 14 years (range 12-16), 168 (68%) patients died (all-cause mortality), of which 56 (23%) were due to cardiac causes. Nonfatal MI occurred in 19 (8%) patients. Kaplan-Meier survival curves showed that MPI provided optimal risk stratification in patients with normal and abnormal MPI. Multivariable analysis identified an abnormal MPI as a strong significant predictor of all-cause mortality and cardiac events. A multivariable analysis also revealed that a reversible defect and SSS were strong long-term predictors of cardiac mortality and hard cardiac events.
  
  
  
  Dobutamine stress99mTc-tetrofosmin SPECT provides incremental prognostic information for the prediction of long-term cardiovascular outcomes in elderly patients, unable to perform exercise testing. Dobutamine stress MPI is useful in risk classifying elderly patients.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Roest
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. henkjan_boiten@hotmail.com.
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Boiten
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.affiliation: Department of Nuclear Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Thoraxcenter Room Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
authors.forename: Arend F L
authors.initials: AFL
authors.lastname: Schinkel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D018450:Disease Progression; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D004280:Dobutamine; C078700:technetium tc-99m tetrofosmin
keywords: 99mTc-tetrofosmin; coronary artery disease; dobutamine stress SPECT; elderly; long-term prognosis