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J Nucl Cardiol. 2013 Dec;20(6):1030-40. doi: 10.1007/s12350-013-9790-3. Epub 2013 Oct 17.

Prediction of 8-year cardiovascular outcomes in patients with systemic arterial hypertension: value of stress (99m)Tc-tetrofosmin myocardial perfusion imaging in a high-risk cohort.

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1
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Room Ba304, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.

Abstract

OBJECTIVE:

Systemic arterial hypertension is a strong and prevalent cardiovascular risk factor. Currently, information on the very long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with systemic arterial hypertension is lacking. The aim of this study was to assess the value of stress (99m)Tc-tetrofosmin MPI for the prediction of very long-term outcome in these patients.

METHODS:

The study population consisted of 608 patients with systemic arterial hypertension who underwent exercise or dobutamine stress (99m)Tc-tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 600 (99%) patients. The endpoints were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of very long-term outcome.

RESULTS:

The mean age of the patients was 59 ± 10 years, and 65% of them were male. MPI findings were normal in 301 patients (50%). Myocardial perfusion abnormalities were fixed in 162 (27%) and reversible in 137 (23%) patients. During a median 8.1-year follow-up, 241 (40%) patients died (121 cardiac deaths), 52 (9%) had a nonfatal myocardial infarction, and 128 (21%) underwent coronary revascularization. Survival curves in patients with a low vs a high summed difference score diverged up to 5 years after the test was performed. Multivariate analyses demonstrated that SPECT MPI provided incremental prognostic information up to 5 years after the test.

CONCLUSIONS:

Stress (99m)Tc-tetrofosmin MPI provides incremental prognostic information for the prediction of cardiovascular outcome in patients with systemic arterial hypertension. Patients with normal stress MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the test is performed.

PMID:
24132813
DOI:
10.1007/s12350-013-9790-3
[Indexed for MEDLINE]
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