Adenosine stress myocardial perfusion imaging in octogenarians: Safety, tolerability, and long-term prognostic implications of hemodynamic response and SPECT-related variables

Journal Article · Fri Feb 15 04:00:00 EST 2019 · Journal of Nuclear Cardiology (Online)

DOI:https://doi.org/10.1007/S12350-017-0893-0· OSTI ID:22962157

Katsikis, Athanasios; Theodorakos, Athanasios; Papaioannou, Spyridon; Kalkinis, Antonios ^[1]; Kolovou, Genovefa ^[2]; Konstantinou, Konstantinos ^[3]; Koutelou, Maria ^[1]

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1. Onassis Cardiac Surgery Center, Nuclear Medicine Department (Greece)
2. Onassis Cardiac Surgery Center, Cardiology Department (Greece)
3. 401 General Military Hospital of Athens, Cardiology Department (Greece)

Background: Evaluation of tolerability, safety, and prognostic implications of adenosine stress myocardial perfusion imaging (MPI) in octogenarians. Methods: 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. Results: 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. Conclusions: In octogenarians, adenosine stress MPI is well tolerated and provides effective long-term risk stratification.

• OSTI ID: 22962157
• Journal Information: Journal of Nuclear Cardiology (Online), Journal Name: Journal of Nuclear Cardiology (Online) Journal Issue: 1 Vol. 26; ISSN 1532-6551
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADENOSINE
BLOOD PRESSURE
CORONARIES
HAZARDS
LUNGS
MYOCARDIAL INFARCTION
PATIENTS
SIDE EFFECTS
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
UPTAKE