Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study

The prognostic importance of various hemodynamic responses to adenosine infusion in patients undergoing adenosine stress myocardial perfusion stress (MPS) has not been defined. We identified 3444 unique patients (53.5% women, mean age 74.0+/-8.4 years) who underwent adenosine (with no additional exe...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2003-06, Vol.107 (23), p.2894-2899
Main Authors: ABIDOV, Aiden, HACHAMOVITCH, Rory, HAYES, Sean W, CHEE KEONG NG, COHEN, Ishac, FRIEDMAN, John D, GERMANO, Guido, BERMAN, Daniel S
Format: Article
Language:English
Subjects:
Adenosine
Aged
Biological and medical sciences
Blood Pressure
Cardiology. Vascular system
Coronary heart disease
Exercise Test
Female
Follow-Up Studies
Heart
Heart - diagnostic imaging
Heart - drug effects
Heart Diseases - diagnosis
Heart Diseases - diagnostic imaging
Heart Diseases - mortality
Heart Rate
Hemodynamics - drug effects
Humans
Male
Medical sciences
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Risk Assessment
Sex Factors
Survival Analysis
Technetium Tc 99m Sestamibi
Thallium Radioisotopes
Tomography, Emission-Computed, Single-Photon
Vasodilator Agents
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Summary:The prognostic importance of various hemodynamic responses to adenosine infusion in patients undergoing adenosine stress myocardial perfusion stress (MPS) has not been defined. We identified 3444 unique patients (53.5% women, mean age 74.0+/-8.4 years) who underwent adenosine (with no additional exercise) stress myocardial perfusion single photon emission computed tomography (MPS) and were followed up for 2.0+/-0.8 years. Multivariable Cox proportional hazards analysis was used to assess the prognostic value of hemodynamic variables in predicting cardiac death (CD). Two hundred twenty-four CDs (6.5%) occurred during follow-up. By multivariable analysis, higher rest heart rate (HR) and to a lesser extent lower peak HR were markers of CD. When added to the multivariable model in place of peak and rest HR, the peak/rest HR ratio was an independent predictor of CD. Peak/rest HR ratio additionally risk-stratified patients within each MPS category. A significant interaction was found between gender and peak systolic blood pressure (SBP), in which there was an increased risk associated with a low peak SBP (
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000072770.27332.75