Prediction of 8-year cardiovascular outcomes in patients with systemic arterial hypertension: value of stress (99m)Tc-tetrofosmin myocardial perfusion imaging in a high-risk cohort

• Published in: Journal of nuclear cardiology Vol. 20; no. 6; pp. 1030 - 1040
• Main Authors: Wai, Marisa C G Tjong Joe, Ottenhof, Machiel J M, Boiten, Hendrik J, Valkema, Roelf, van Domburg, Ron T, Schinkel, Arend F L
• Format: Journal Article
• Language: English
• Published: United States 01-12-2013
• Subjects: Aged; Cohort Studies; Exercise Test; Female; Humans; Hypertension - diagnostic imaging; Hypertension - mortality; Male; Middle Aged; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Risk Factors; Tomography, Emission-Computed, Single-Photon
• ISSN: 1532-6551
• DOI: 10.1007/s12350-013-9790-3

Systemic arterial hypertension is a strong and prevalent cardiovascular risk factor. Currently, information on the very long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with systemic arterial hypertension is lacking. The aim of this study was to assess the value of stress (99m)Tc-tetrofosmin MPI for the prediction of very long-term outcome in these patients.
The study population consisted of 608 patients with systemic arterial hypertension who underwent exercise or dobutamine stress (99m)Tc-tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 600 (99%) patients. The endpoints were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of very long-term outcome.
The mean age of the patients was 59 ± 10 years, and 65% of them were male. MPI findings were normal in 301 patients (50%). Myocardial perfusion abnormalities were fixed in 162 (27%) and reversible in 137 (23%) patients. During a median 8.1-year follow-up, 241 (40%) patients died (121 cardiac deaths), 52 (9%) had a nonfatal myocardial infarction, and 128 (21%) underwent coronary revascularization. Survival curves in patients with a low vs a high summed difference score diverged up to 5 years after the test was performed. Multivariate analyses demonstrated that SPECT MPI provided incremental prognostic information up to 5 years after the test.
Stress (99m)Tc-tetrofosmin MPI provides incremental prognostic information for the prediction of cardiovascular outcome in patients with systemic arterial hypertension. Patients with normal stress MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the test is performed.