Hemodynamic variables during stress testing can predict referral to early catheterization but failed to show a prognostic impact on emerging cardiac events in patients aged 70 years and older undergoing exercise 99mTc-sestamibi myocardial perfusion scintigraphy

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Foundation for Research Background Asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) are known to be at an increased risk of major cardiac events (MACE) at 2-years follow-up. It remains unclear whether this finding holds true even for a follow-up of 5 years. Methods four hundred patients with type-2 diabetes without coronary artery disease were evaluated clinically and with MPS and followed up for 5 years. Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction or late coronary revascularization. Results An abnormal MPS (SSS≥4 or SSS≥2) was found in 87 patients (21.8%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%, p = 0.009); 15 deaths were recorded (3.8%). Patients with normal MPS had lower rates of MACEs than patients with abnormal scans (p = 0.016) (Figure 1A + B). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (Figure 1C + D). Conclusions Patients with normal MPS have a low event rate and may not need retesting within 5 years (warranty period). Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach. Abstract Figure 1 A-D

Download Full-text

Stress testing for myocardial perfusion scintigraphy

10.1093/med/9780198759942.003.0007 ◽

2017 ◽

Author(s):

Nikant Sabharwal ◽

Parthiban Arumugam ◽

Andrew Kelion

Keyword(s):

Myocardial Perfusion ◽

Stress Testing ◽

Myocardial Perfusion Scintigraphy ◽

Stress Test ◽

Arterial System ◽

Exercise Stress ◽

Perfusion Scintigraphy ◽

Advantages And Disadvantages ◽

Patient Preparation ◽

Aid Decision

This chapter focuses on stress testing for myocardial perfusion scintigraphy. Beginning with detail on coronary physiology and exercise testing, it explains the coronary arterial system and the effect of stress methods on flow. By providing practical details on stress testing and exercise stress including equipment, personnel, and patient preparation, this chapter provides a good basis for clinical practice. Information on vasodilator drugs is also provided, with detail on pharmacology, practical considerations when performing the stress test, and adverse effects. Similar detail is provided on dobutamine. A further section details the advantages and disadvantages of methods of stress, including cost considerations, side effects, and variable suitability for a range of patients. A handy and practical algorithm is also provided to aid decision-making for appropriate methods of stress.

Download Full-text

Stress testing for myocardial perfusion scintigraphy

10.1093/med/9780199206445.003.0007 ◽

2011 ◽

Author(s):

Nikant Sabharwal ◽

Chee Yee Loong ◽

Andrew Kelion

Keyword(s):

Myocardial Perfusion ◽

Stress Testing ◽

Myocardial Perfusion Scintigraphy ◽

Stress Test ◽

Exercise Stress ◽

Perfusion Scintigraphy ◽

Coronary Physiology ◽

Vasodilator Drugs ◽

Patient Preparation

Coronary physiology and stress testing 76Practical requirements for stress testing 78Patient preparation for stress 80Exercise stress: general considerations 82Exercise stress: practical aspects 84Exercise stress: performing the test 86Vasodilator drugs: pharmacology 88Vasodilator drugs: practical considerations 92Vasodilator drugs: performing the stress test ...

Download Full-text