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J Am Coll Cardiol, 2001; 38:1511-1517 © 2001 by the American College of Cardiology Foundation |
* 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.
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