title: Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine99mTc-sestamibi SPECT?
abstract: BACKGROUND
  Both dobutamine stress echocardiography (DSE) and myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) are frequently used for cardiac risk stratification. The long-term relative prognostic value of these modalities has not been studied. Therefore, this study evaluated the long-term prognostic value of DSE compared to MPI in patients unable to perform exercise testing.
  
  
  METHODS
  This prospective, single center study included 301 patients (mean age 59 ± 12 years, 56% men) unable to perform exercise tests who underwent DSE and dobutamine stress99mTc-sestamibi MPI. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI). Univariable and multivariable Cox proportional hazards regression models were used to identify independent predictors of outcome. The probability of survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 182 patients (60%) had an abnormal DSE and 198 (66%) patients had an abnormal MPI. The agreement between DSE and MPI was 82% (κ = 0.62). During a median follow-up of 14 years (range 5-18), 172 deaths (57%) occurred, of which 72 (24%) were due to cardiac causes. Nonfatal MI occurred in 46 patients (15%). The multivariable analysis demonstrated that an abnormal DSE was a significant predictor of cardiac mortality (HR 2.35, 95% CI [1.17-4.73]) and hard cardiac events (HR 2.11, 95% CI [1.25-3.57]). Also, an abnormal MPI result was a significant predictor of cardiac mortality (HR 3.03, 95% CI [1.33-6.95]) and hard cardiac events (HR 2.06, 95% CI [1.12-3.79]).
  
  
  CONCLUSIONS
  DSE and MPI are comparable in predicting long-term cardiac mortality and hard cardiac events in patients unable to perform exercise testing.
authors.affiliation: Department of Cardiology, Thoraxcenter Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands. henkjan_boiten@hotmail.com.
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Boiten
authors.affiliation: Department of Cardiology, Thoraxcenter Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.affiliation: Department of Cardiology, Thoraxcenter Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
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 Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.affiliation: Department of Cardiology, Thoraxcenter Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
authors.forename: Arend F L
authors.initials: AFL
authors.lastname: Schinkel
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D004280:Dobutamine / Q000737:chemistry*; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi
keywords: DSE; SPECT; cardiac events; long-term prognostic value; myocardial perfusion imaging