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

• Published in: The international journal of cardiovascular imaging 2009-08, Vol.25 (6), p.569-579
• Main Authors: Bucerius, Jan, Joe, Alexius Y, Herder, Ellen, Brockmann, Holger, Biermann, Kim, Palmedo, Holger, Tiemann, Klaus, Biersack, Hans-Jürgen
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aged, 80 and over; Blood Pressure; Coronary Angiography; Coronary Circulation; Disease-Free Survival; Electrocardiography; Exercise Test; Female; Heart Diseases - diagnostic imaging; Heart Diseases - mortality; Heart Diseases - physiopathology; Heart Rate; Hemodynamics; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Myocardial Perfusion Imaging - methods; Odds Ratio; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Referral and Consultation; Retrospective Studies; Risk Assessment; Risk Factors; Technetium Tc 99m Sestamibi; Time Factors; Tomography, Emission-Computed, Single-Photon
• ISSN: 1875-8312
• DOI: 10.1007/s10554-009-9461-2

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 ( 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.