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Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?

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,...

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Autores principales: Boiten, Hendrik J., van Domburg, Ron T., Geleijnse, Marcel L., Valkema, Roelf, Zijlstra, Felix, Schinkel, Arend F. L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869882/
https://www.ncbi.nlm.nih.gov/pubmed/27444501
http://dx.doi.org/10.1007/s12350-016-0521-4
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author Boiten, Hendrik J.
van Domburg, Ron T.
Geleijnse, Marcel L.
Valkema, Roelf
Zijlstra, Felix
Schinkel, Arend F. L.
author_facet Boiten, Hendrik J.
van Domburg, Ron T.
Geleijnse, Marcel L.
Valkema, Roelf
Zijlstra, Felix
Schinkel, Arend F. L.
author_sort Boiten, Hendrik J.
collection PubMed
description 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 stress (99m)Tc-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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12350-016-0521-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-58698822018-03-28 Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT? Boiten, Hendrik J. van Domburg, Ron T. Geleijnse, Marcel L. Valkema, Roelf Zijlstra, Felix Schinkel, Arend F. L. J Nucl Cardiol Original Article 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 stress (99m)Tc-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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12350-016-0521-4) contains supplementary material, which is available to authorized users. Springer US 2016-07-21 2018 /pmc/articles/PMC5869882/ /pubmed/27444501 http://dx.doi.org/10.1007/s12350-016-0521-4 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Boiten, Hendrik J.
van Domburg, Ron T.
Geleijnse, Marcel L.
Valkema, Roelf
Zijlstra, Felix
Schinkel, Arend F. L.
Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title_full Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title_fullStr Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title_full_unstemmed Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title_short Cardiac stress imaging for the prediction of very long-term outcomes: Dobutamine stress echocardiography or dobutamine (99m)Tc-sestamibi SPECT?
title_sort cardiac stress imaging for the prediction of very long-term outcomes: dobutamine stress echocardiography or dobutamine (99m)tc-sestamibi spect?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869882/
https://www.ncbi.nlm.nih.gov/pubmed/27444501
http://dx.doi.org/10.1007/s12350-016-0521-4
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