This Article Abstract 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.

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

View larger version (14K): [in a new window]   Figure 1 Event-free survival according to the dobutamine technetium-99m-sestamibi single-photon emission computed tomography (SPECT) results. Event-free survival is significantly better in patients with normal SPECT results than it is in those with abnormal SPECT results. The curves begin to diverge early, with relatively few cardiac events during the first year of follow-up in patients with normal SPECT results.

View larger version (16K): [in a new window]   Figure 2 Event-free survival in patients with abnormal single-photon emission computed tomography (SPECT) results segregated according to the presence or absence of perfusion defect reversibility. Although the event-free survival is significantly reduced in both of the abnormal SPECT groups relative to those with normal SPECT results, no significant effect of perfusion defect reversibility was observed on event-free survival.

View larger version (14K): [in a new window]   Figure 3 Event-free survival according to the electrocardiogram (ECG) response and the single-photon emission computed tomography (SPECT) results. The event-free survival was significantly and independently associated with both ECG (p = 0.035) and SPECT (p = 0.012) results. Patients with normal ECG responses and normal SPECT results had a very favorable event-free survival (p = 0.0062 vs. other groups). Patients with abnormal ECG responses and abnormal SPECT results had a very high event rate.

View larger version (31K): [in a new window]   Figure 4 The impact of population risk on the annual cardiac event rates after single-photon emission computed tomography (SPECT) perfusion imaging. Excellent risk stratification is achieved with both exercise and dobutamine SPECT imaging as reflected by a roughly fivefold differential in event rates between patients with normal and abnormal SPECT results. However, regardless of SPECT results, event rates are higher in patients referred for dobutamine stress than they are in those referred for exercise stress, reflecting the higher intrinsic cardiac risk in patients referred for dobutamine perfusion imaging.