Katsikis Athanasios, Theodorakos Athanasios, Papaioannou Spyridon, Kalkinis Antonios, Kolovou Genovefa, Konstantinou Konstantinos, Koutelou Maria
Nuclear Medicine Department, Onassis Cardiac Surgery Center, Athens, Greece.
Cardiology Department, 401 General Military Hospital of Athens, Athens, Greece.
J Nucl Cardiol. 2019 Feb;26(1):250-262. doi: 10.1007/s12350-017-0893-0. Epub 2017 Apr 26.
Evaluation of tolerability, safety, and prognostic implications of adenosine stress myocardial perfusion imaging (MPI) in octogenarians.
370 octogenarians (49% known coronary artery disease) were studied. Hemodynamic response, MPI-related data, and rest-left ventricular ejection fraction (LVEF) based on echocardiography were registered per patient, and prospective follow-up was performed to document all-cause death (ACD), cardiac death (CD), myocardial infarction (MI), and late revascularization.
No deaths or MIs were observed during adenosine infusion or the short-term post-infusion period. 86% of patients were able to tolerate a 6-minute infusion. All side effects terminated spontaneously after infusion cessation, except for one case of pulmonary oedema. After 9.3 years, there were 124 ACDs, 62 CDs, 16 MIs, and 35 revascularizations. Differences between survival curves of summed stress score (SSS)-based risk groups were significant for all end points (P < .001). SSS and LVEF were independent predictors of all end points (P ≤ .01) and lung uptake of cardiac end points. ΔHR <10 bpm (OR = 1.78, P = .004) and inability to increase HR by >10 bpm and decrease systolic blood pressure by >10 mmHg (OR = 2, P = .02) during adenosine infusion were independent predictors of ACD and CD, respectively. Hemodynamic response variables, SSS, and lung uptake provided incremental prognostic value over pre-test data for ACD and CD.
In octogenarians, adenosine stress MPI is well tolerated and provides effective long-term risk stratification.
评估八旬老人腺苷负荷心肌灌注成像（MPI）的耐受性、安全性及预后意义。
对370名八旬老人（49%已知患有冠状动脉疾病）进行研究。记录每位患者的血流动力学反应、MPI相关数据以及基于超声心动图的静息左心室射血分数（LVEF），并进行前瞻性随访以记录全因死亡（ACD）、心源性死亡（CD）、心肌梗死（MI）和晚期血运重建情况。
在腺苷输注期间或输注后短期内未观察到死亡或心肌梗死病例。86%的患者能够耐受6分钟的输注。除1例肺水肿外，所有副作用在输注停止后均自行终止。9.3年后，发生124例全因死亡、62例心源性死亡、16例心肌梗死和35例血运重建。基于总负荷评分（SSS）的风险组生存曲线在所有终点上的差异均具有显著性（P <.001）。SSS和LVEF是所有终点（P≤.01）以及心脏终点肺部摄取的独立预测因素。腺苷输注期间ΔHR <10次/分钟（OR = 1.78，P =.004）以及无法使心率增加>10次/分钟且收缩压降低>10 mmHg（OR = 2，P =.02）分别是全因死亡和心源性死亡的独立预测因素。血流动力学反应变量、SSS和肺部摄取相对于检测前数据为全因死亡和心源性死亡提供了额外的预后价值。
在八旬老人中，腺苷负荷MPI耐受性良好，并能提供有效的长期风险分层。
