Document Detail


Long-term prognostic value of dobutamine stress 99mTc-sestamibi SPECT: single-center experience with 8-year follow-up.
MedLine Citation:
PMID:  12461248     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To determine the long-term prognostic value of dobutamine stress technetium 99m (99mTc)-labeled sestamibi single photon emission computed tomography (SPECT) in patients with limited exercise capacity. MATERIALS AND METHODS: Clinical data and SPECT results were analyzed in 531 consecutive patients. Follow-up was successful in 528 (99.4%) patients; 55 underwent early revascularization and were excluded. Normal or abnormal findings were considered in the absence or presence of fixed and/or reversible perfusion defects. A summed stress score was calculated to estimate the extent and severity of perfusion defects. Univariate and multivariate Cox proportional hazards regression models were used to identify independent predictors of late cardiac events. The incremental value of myocardial perfusion scintigraphy over clinical variables in predicting events was determined according to two models. The probability of survival was calculated by using the Kaplan-Meier method. RESULTS: Findings were abnormal in 312 patients. During 8.0 years +/- 1.5 of follow-up (range, 4.5-10.6 years), cardiac death occurred in 67 patients (total deaths, 165); nonfatal myocardial infarction, in 34; and late revascularization, in 49. The annual rates for cardiac death, cardiac death or infarction, and all events were 0.9%, 1.2%, and 1.5%, respectively, after normal findings and 2.7%, 3.4%, and 4.4%, respectively, after abnormal findings (P <.05). In a multivariable Cox proportional hazards model, not only an abnormal finding but also the summed stress score provided incremental prognostic information in addition to clinical data. The hazard ratio for cardiac death was 1.09 (95% CI: 1.01, 1.18) per 1-unit increment of the summed stress score. CONCLUSION: The incremental prognostic value of dobutamine stress 99mTc-sestamibi SPECT over clinical data was maintained over an 8-year follow-up in patients with limited exercise capacity.
Authors:
Arend F L Schinkel; Abdou Elhendy; Ron T Van Domburg; Jeroen J Bax; Roelf Valkema; Jos R T C Roelandt; Don Poldermans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Radiology     Volume:  225     ISSN:  0033-8419     ISO Abbreviation:  Radiology     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-12-03     Completed Date:  2003-01-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  701-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Erasmus Medical Center Rotterdam, Dr Molewaterplein 40, Thoraxcenter Rm Ba 300, 3015 GD Rotterdam, the Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / mortality,  radionuclide imaging*
Dobutamine / diagnostic use*
Exercise Test
Female
Follow-Up Studies
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Radiopharmaceuticals / diagnostic use*
Technetium Tc 99m Sestamibi / diagnostic use*
Time Factors
Tomography, Emission-Computed, Single-Photon / methods*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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