This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calnon, D. A. Articles by Beller, G. A. Search for Related Content PubMed PubMed Citation Articles by Calnon, D. A. Articles by Beller, G. A.

STRESS TESTING

Prognostic value of dobutamine stress technetium-99m-sestamibi single-photon emission computed tomography myocardial perfusion imaging: stratification of a high-risk population

Dennis A. Calnon, MD, FACC^*, Paul D. McGrath, MD, MSc, FACC^*, Amanda L. Doss, MEd^*, Frank E. Harrell, Jr, PhD, Denny D. Watson, PhD and George A. Beller, MD, FACC^*,*

^* Cardiovascular Division, Department of Medicine, Charlottesville, Virginia, USA
Division of Biostatistics and Epidemiology, Department of Health Evaluation Sciences, Charlottesville, Virginia, USA
Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA

Manuscript received March 13, 2000; revised manuscript received June 12, 2001, accepted July 11, 2001.

^* Reprint requests and correspondence: Dr. George A. Beller, Cardiovascular Division, Department of Medicine, P.O. Box 800158, University of Virginia Health System, Charlottesville, Virginia 22908-0158 USA
gbeller{at}virginia.edu

OBJECTIVES

This work was undertaken to define the intrinsic cardiac risk of the patient population referred for dobutamine stress perfusion imaging and to determine whether dobutamine technetium-99m (^99mTc)-sestamibi single-photon emission computed tomography (SPECT) imaging is capable of risk stratification in this population.

BACKGROUND

In animal models, dobutamine attenuates the myocardial uptake of ^99mTc-sestamibi resulting in underestimation of coronary stenoses. Therefore, we hypothesized that the prognostic value of dobutamine stress ^99mTc-sestamibi SPECT myocardial perfusion imaging might be impaired, owing to reduced detection of coronary stenoses.

METHODS

We reviewed the clinical outcome of 308 patients (166 women, 142 men) who underwent dobutamine stress SPECT ^99mTc-sestamibi imaging at our institution from September 1992 through December 1996.

RESULTS

During an average follow-up of 1.9 ± 1.1 years, there were 33 hard cardiac events (18 myocardial infarctions [MI] and 15 cardiac deaths) corresponding to an annual cardiac event rate of 5.8%/year, which is significantly higher than the event rate for patients referred for exercise SPECT imaging at our institution (2.2%/year). Event rates were higher after an abnormal dobutamine ^99mTc-sestamibi SPECT study (10.0%/year) than after a normal study (2.3%/year) (p < 0.01), even after adjusting for clinical variables. In the subgroup (n = 29) with dobutamine-induced ST-segment depression and abnormal SPECT imaging, the prognosis was poor, with annual cardiac death and nonfatal MI rates of 7.9% and 13.2%, respectively.

CONCLUSIONS

Patients referred for dobutamine perfusion imaging are a high-risk population, and dobutamine stress ^99mTc-sestamibi SPECT imaging is capable of risk stratification in these patients.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiogram   MI = myocardial infarction   SPECT = single-photon emission computed tomography/tomographic   99mTc = technetium-99m   %MAPHR = percentage of maximum age-predicted heart rate

This article has been cited by other articles:

				C. Doesch, A. Seeger, J. Doering, C. Herdeg, C. Burgstahler, C. D. Claussen, M. Gawaz, S. Miller, and A. E. May Risk Stratification by Adenosine Stress Cardiac Magnetic Resonance in Patients With Coronary Artery Stenoses of Intermediate Angiographic Severity J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 424 - 433. [Abstract] [Full Text] [PDF]

				S. M. Navare, J. F. Mather, and G. V. Heller Reply J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1472 - 1473. [Full Text] [PDF]

				S. M. Navare, D. Katten, L. L. Johnson, J. F. Mather, M. S. Fowler, A. W. Ahlberg, N. Miele, and G. V. Heller Risk Stratification With Electrocardiographic-Gated Dobutamine Stress Technetium-99m Sestamibi Single-Photon Emission Tomographic Imaging: Value of Heart Rate Response and Assessment of Left Ventricular Function J. Am. Coll. Cardiol., February 21, 2006; 47(4): 781 - 788. [Abstract] [Full Text] [PDF]

				J. M. Tsutsui, A. Elhendy, J. R. Anderson, F. Xie, A. C. McGrain, and T. R. Porter Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography Circulation, September 6, 2005; 112(10): 1444 - 1450. [Abstract] [Full Text] [PDF]

				A. F.L. Schinkel, A. Elhendy, E. Biagini, R. T. van Domburg, R. Valkema, V. Rizello, C. Pedone, M. Simoons, J. J. Bax, and D. Poldermans Prognostic Stratification Using Dobutamine Stress 99mTc-Tetrofosmin Myocardial Perfusion SPECT in Elderly Patients Unable to Perform Exercise Testing J. Nucl. Med., January 1, 2005; 46(1): 12 - 18. [Abstract] [Full Text] [PDF]

				R. Hachamovitch, S. Hayes, J. D. Friedman, I. Cohen, L. J. Shaw, G. Germano, and D. S. Berman Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: What is the warranty period of a normal scan? J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1329 - 1340. [Abstract] [Full Text] [PDF]

				A. Elhendy, J. J. Bax, and D. Poldermans Dobutamine Stress Myocardial Perfusion Imaging in Coronary Artery Disease J. Nucl. Med., December 1, 2002; 43(12): 1634 - 1646. [Abstract] [Full Text] [PDF]

				A. F. L. Schinkel, A. Elhendy, R. T. van Domburg, J. J. Bax, R. Valkema, J. R. T. C. Roelandt, and D. Poldermans Long-term Prognostic Value of Dobutamine Stress 99mTc-Sestamibi SPECT: Single-Center Experience with 8-year Follow-up Radiology, December 1, 2002; 225(3): 701 - 706. [Abstract] [Full Text] [PDF]

				A. F.L. Schinkel, A. Elhendy, R. T. van Domburg, J. J. Bax, J. R.T.C. Roelandt, and D. Poldermans Prognostic Value of Dobutamine-Atropine Stress 99mTc-Tetrofosmin Myocardial Perfusion SPECT in Patients with Known or Suspected Coronary Artery Disease J. Nucl. Med., June 1, 2002; 43(6): 767 - 772. [Abstract] [Full Text] [PDF]

				D. A. Calnon and G. A. Beller Reply J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1708 - 1709. [Full Text] [PDF]

				R. S. Druz Dobutamine stress testing revisited J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1708 - 1708. [Full Text] [PDF]