Document Detail


Prognostic value of exercise stress technetium-99m-tetrofosmin myocardial perfusion imaging in patients with normal baseline electrocardiograms.
MedLine Citation:
PMID:  16923441     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Exercise stress electrocardiography is the recommended method for cardiac evaluation of patients with normal electrocardiograms (ECGs). There are no data to indicate an independent value of myocardial perfusion imaging (MPI) in predicting mortality in these patients. This study assessed the value of exercise stress MPI in predicting mortality in patients with normal baseline ECGs. We studied 319 patients (55 +/- 10 years of age; 180 men) with normal ECGs by exercise stress technetium-99m tetrofosmin MPI. End points during follow-up were cardiac and all-cause mortalities and hard cardiac events. A normal scan was detected in 190 patients (60%). Myocardial perfusion abnormalities were fixed in 59 patients (18%) and reversible in 70 (23%). During a mean follow-up of 7 +/- 1.2 years, 46 patients (14%) died. Death was considered cardiac in 28 patients (9%). Nonfatal myocardial infarction occurred in 12 patients (4%). Annual cardiac death rates were 0.4% in patients with normal perfusion, and 2.7% in patients with reversible defects. Annual total mortality rates were 1.1% in patients with normal perfusion and 3.4% in patients with reversible defects. In a multivariate analysis model, reversible perfusion abnormalities were associated with cardiac death (RR 2.8, 95% confidence interval 1.6 to 5.1) and hard cardiac events (RR 2.7, 95% confidence interval 1.5 to 4.5). Perfusion abnormalities in multivessel distribution were predictive of all-cause mortality (RR 2, 95% confidence interval 1.4 to 3.2). ST-segment depression was not significantly associated with events. In conclusion, stress technetium-99m tetrofosmin MPI provides independent information for predicting cardiac and overall mortalities in patients with normal ECGs. Reversible perfusion abnormalities, but not ischemic electrocardiographic changes, are predictive of outcome in these patients.
Authors:
Abdou Elhendy; Arend F L Schinkel; Ron T van Domburg; Jeroen J Bax; Roelf Valkema; Aukje Huurman; Harm H H Feringa; Don Poldermans
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-06-30
Journal Detail:
Title:  The American journal of cardiology     Volume:  98     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2006 Sep 
Date Detail:
Created Date:  2006-08-22     Completed Date:  2006-09-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  585-90     Citation Subset:  AIM; IM    
Affiliation:
Thoraxcenter, University Hospital Rotterdam, Rotterdam, The Netherlands. aelhendy@unmc.edu
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MeSH Terms
Descriptor/Qualifier:
Electrocardiography*
Exercise Test / methods*
Female
Follow-Up Studies
Humans
Injections, Intravenous
Male
Middle Aged
Myocardial Ischemia / mortality,  physiopathology,  radionuclide imaging*
Organophosphorus Compounds / administration & dosage,  diagnostic use*
Organotechnetium Compounds / administration & dosage,  diagnostic use*
Prognosis
Radiopharmaceuticals / administration & dosage,  diagnostic use*
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Rate
Tomography, Emission-Computed, Single-Photon / methods*
Chemical
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/Radiopharmaceuticals; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane

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


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