INTRODUCTION: The prognostic value of a blunted heart rate response (BHR) during ECG-gated vasodilator stress SPECT MPI in relation to ventricular function on long-term cardiovascular events is not well established. We performed this study to evaluate the incremental prognostic value of BHR during pharmacological stress SPECT MPI. METHODS: Consecutive patients who underwent dipyridamole stress Tc-99m sestamibi ECG-gated SPECT MPI (without exercise) were identified. The ratio of peak stress heart rate to baseline was noted. If the ratio was <1.20, it was considered blunted (BHR). The images were interpreted using the standard ASNC 17 segment model. Patients were followed up for a mean time period of 2.3 +/- 1.5 years. RESULTS: Sixty-four percent (2,890/4,484) of patients demonstrated BHR during dipyridamole stress testing. Cardiac death, the primary end point, occurred in 6.8% of patients. Patients with BHR had a significantly lower cardiac death-free survival as compared to NO BHR group in total population (83% vs 94%; P < .001) as well as in subgroup with normal ejection fraction (89% vs 96%; P < .001). BHR was an independent predictor of cardiac death after adjusting for multiple clinical, perfusion, and function-related gated SPECT variables. CONCLUSION: Blunted heart rate response during vasodilator stress SPECT MPI is an important prognostic marker for cardiac death.
INTRODUCTION: The prognostic value of a blunted heart rate response (BHR) during ECG-gated vasodilator stress SPECT MPI in relation to ventricular function on long-term cardiovascular events is not well established. We performed this study to evaluate the incremental prognostic value of BHR during pharmacological stress SPECT MPI. METHODS: Consecutive patients who underwent dipyridamole stress Tc-99m sestamibi ECG-gated SPECT MPI (without exercise) were identified. The ratio of peak stress heart rate to baseline was noted. If the ratio was <1.20, it was considered blunted (BHR). The images were interpreted using the standard ASNC 17 segment model. Patients were followed up for a mean time period of 2.3 +/- 1.5 years. RESULTS: Sixty-four percent (2,890/4,484) of patients demonstrated BHR during dipyridamole stress testing. Cardiac death, the primary end point, occurred in 6.8% of patients. Patients with BHR had a significantly lower cardiac death-free survival as compared to NO BHR group in total population (83% vs 94%; P < .001) as well as in subgroup with normal ejection fraction (89% vs 96%; P < .001). BHR was an independent predictor of cardiac death after adjusting for multiple clinical, perfusion, and function-related gated SPECT variables. CONCLUSION: Blunted heart rate response during vasodilator stress SPECT MPI is an important prognostic marker for cardiac death.
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Authors: T Sharir; G Germano; X Kang; H C Lewin; R Miranda; I Cohen; R D Agafitei; J D Friedman; D S Berman Journal: J Nucl Med Date: 2001-06 Impact factor: 10.057
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Authors: Punitha Arasaratnam; Masoud Sadreddini; Yeung Yam; Vinay Kansal; Sharmila Dorbala; Marcelo F Di Carli; Rob S Beanlands; Michael E Merhige; Brent A Williams; Emir Veledar; James K Min; Li Chen; Terrence D Ruddy; Guido Germano; Daniel S Berman; Leslee J Shaw; Benjamin J W Chow Journal: Eur J Nucl Med Mol Imaging Date: 2017-11-27 Impact factor: 9.236