Department of Cardiology, Thoraxcenter Room Ba304, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands.
Department of Nuclear Medicine, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
J Nucl Cardiol. 2018 Apr;25(2):471-479. doi: 10.1007/s12350-016-0521-4. Epub 2016 Jul 21.
Both dobutamine stress echocardiography (DSE) and myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) are frequently used for cardiac risk stratification. The long-term relative prognostic value of these modalities has not been studied. Therefore, this study evaluated the long-term prognostic value of DSE compared to MPI in patients unable to perform exercise testing.
This prospective, single center study included 301 patients (mean age 59 ± 12 years, 56% men) unable to perform exercise tests who underwent DSE and dobutamine stress Tc-sestamibi MPI. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction (MI). Univariable and multivariable Cox proportional hazards regression models were used to identify independent predictors of outcome. The probability of survival was calculated using the Kaplan-Meier method.
A total of 182 patients (60%) had an abnormal DSE and 198 (66%) patients had an abnormal MPI. The agreement between DSE and MPI was 82% (κ = 0.62). During a median follow-up of 14 years (range 5-18), 172 deaths (57%) occurred, of which 72 (24%) were due to cardiac causes. Nonfatal MI occurred in 46 patients (15%). The multivariable analysis demonstrated that an abnormal DSE was a significant predictor of cardiac mortality (HR 2.35, 95% CI [1.17-4.73]) and hard cardiac events (HR 2.11, 95% CI [1.25-3.57]). Also, an abnormal MPI result was a significant predictor of cardiac mortality (HR 3.03, 95% CI [1.33-6.95]) and hard cardiac events (HR 2.06, 95% CI [1.12-3.79]).
DSE and MPI are comparable in predicting long-term cardiac mortality and hard cardiac events in patients unable to perform exercise testing.
多巴酚丁胺负荷超声心动图（DSE）和单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）常用于心脏风险分层。这些方法的长期相对预后价值尚未得到研究。因此，本研究评估了 DSE 与不能进行运动试验的患者相比，MPI 的长期预后价值。
这是一项前瞻性、单中心研究，纳入了 301 名（平均年龄 59 ± 12 岁，56%为男性）不能进行运动试验的患者，他们接受了 DSE 和多巴酚丁胺负荷 Tc- sestamibi MPI。随访期间的终点是全因死亡率、心脏死亡率和非致死性心肌梗死（MI）。采用单变量和多变量 Cox 比例风险回归模型确定预后的独立预测因素。使用 Kaplan-Meier 方法计算生存率。
共有 182 名患者（60%）的 DSE 结果异常，198 名患者（66%）的 MPI 结果异常。DSE 和 MPI 的一致性为 82%（κ=0.62）。在中位数为 14 年（范围 5-18 年）的随访期间，发生了 172 例死亡（57%），其中 72 例（24%）是由心脏原因引起的。46 名患者（15%）发生非致死性 MI。多变量分析表明，DSE 异常是心脏死亡率（HR 2.35，95%CI [1.17-4.73]）和严重心脏事件（HR 2.11，95%CI [1.25-3.57]）的显著预测因素。此外，MPI 结果异常也是心脏死亡率（HR 3.03，95%CI [1.33-6.95]）和严重心脏事件（HR 2.06，95%CI [1.12-3.79]）的显著预测因素。
在不能进行运动试验的患者中，DSE 和 MPI 在预测长期心脏死亡率和严重心脏事件方面具有可比性。
