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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

Sachin M. Navare, MD^_*,, Deborah Katten, RN, MPH^_*, Lynne L. Johnson, MD^,, Jeffery F. Mather, MS^_*, Michael S. Fowler, MD^_*,, Alan W. Ahlberg, MA^_*, Nicholas Miele, BS^, and Gary V. Heller, MD, PhD^_*,,_*

^_* Nuclear Cardiology Laboratory of the Henry Low Heart Center, Hartford Hospital, Hartford, Connecticut
University of Connecticut School of Medicine, Farmington, Connecticut
Nuclear Cardiology Laboratory, Cardiology Division of the Rhode Island Hospital, Providence, Rhode Island
Brown University School of Medicine, Providence, Rhode Island. This study was partially supported by a research grant from Bristol-Myers Squibb Medical Imaging (Billerica, Massachusetts). Dr. Heller receives research support and honoraria from Bristol-Myers Squibb

View larger version (10K): [in a new window]   Figure 1 Rates of cardiac death (CD) (open bars) and non-fatal myocardial infarction (MI) (solid bars) in relation to the severity of perfusion abnormality. The number of patients in each category is given in parentheses; the numbers above the bars represent the event rates, and the numbers within the bars denote the actual number of events. The data demonstrate increasing annualized CD and MI rates with increasing summed stress score (SSS).

View larger version (11K): [in a new window]   Figure 2 Rates of cardiac death (CD) (open bars) and myocardial infarction (MI) (solid bars) plotted according to left ventricular (LV) systolic function as measured by ejection fraction (EF) by gated single-photon emission computed tomography. Cardiac events increased with worsening LV function with a sharp increase in CD with severely depressed LV function.

View larger version (16K): [in a new window]   Figure 3 Kaplan-Meier analysis demonstrating cardiac event-free survival according to combined assessment of perfusion and function. The number of patients at each time interval is given in parenthesis.

View larger version (16K): [in a new window]   Figure 4 Kaplan-Meier analysis showing incremental prognostic value of electrocardiogram response to dobutamine over perfusion for risk stratification. The number of patients at each time interval is given in parenthesis.

View larger version (16K): [in a new window]   Figure 5 Importance of achieving target heart rate in response to dobutamine infusion. Low-risk category is represented by patients with normal electrocardiogram (ECG) response, normal perfusion and function; the high-risk category is represented by patients with abnormal ECG response and abnormal perfusion and function, while intermediate-risk category is represented by patients with either abnormality. MPHR = maximum predicted heart rate.