Steingart Richard M, Hodnett Patty, Musso Joseph, Feuerman Martin
Division of Cardiology, Winthrop-University Hospital, Mineola, NY 11501, USA.
J Nucl Cardiol. 2002 Nov-Dec;9(6):573-80. doi: 10.1067/mnc.2002.127013.
Exercise myocardial perfusion imaging (MPI) has significant value for risk stratification, but most patients studied have been middle-aged. In particular, the value of exercise MPI in elderly patients with interpretable electrocardiographic (ECG) stress test results has not been well defined. MEHODS AND RESULTS: Clinical, ECG stress test, MPI, and follow-up data for 626 outpatients aged 65 years or older with interpretable electrocardiograms undergoing symptom-limited exercise MPI between 1992 and 1996 were analyzed. Follow-up was 97% complete after 4.4 +/- 1.3 years. After exclusion of the 27 patients who underwent revascularization within 90 days of MPI, there were 361 men and 217 women, aged 70.7 +/- 4.4 years. By univariate analysis, male sex, increasing age, an abnormal rest ECG result, lower exercise tolerance and lower peak exercise heart rates, exercise ST-segment depression, left ventricular dilatation, and the number of ischemic regions predicted death or myocardial infarction. By multivariable modeling, only increasing patient age, male sex, limitation of exercise tolerance, and the number of ischemic segments by MPI were predictive of subsequent death or myocardial infarction.
In elderly patients referred for exercise MPI, age, sex, exercise tolerance, and MPI ischemia provide significant prognostic information.
运动心肌灌注成像（MPI）在风险分层方面具有重要价值，但大多数研究对象为中年患者。特别是，运动MPI在老年患者中，其心电图（ECG）运动试验结果可解释时的价值尚未明确界定。
分析了1992年至1996年间626例年龄在65岁及以上、心电图可解释、接受症状限制性运动MPI的门诊患者的临床、ECG运动试验、MPI及随访数据。随访在4.4±1.3年后完成率为97%。排除在MPI后90天内接受血管重建的27例患者后，有361名男性和217名女性，年龄为70.7±4.4岁。单因素分析显示，男性、年龄增加、静息ECG结果异常、运动耐量降低、运动高峰心率降低、运动时ST段压低、左心室扩张以及缺血区域数量可预测死亡或心肌梗死。多变量建模显示，仅患者年龄增加、男性、运动耐量受限以及MPI显示的缺血节段数量可预测随后的死亡或心肌梗死。
在接受运动MPI检查的老年患者中，年龄、性别、运动耐量和MPI缺血情况可提供重要的预后信息。
