Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images

Elizabeth Klodas, Todd D. Miller, Timothy F. Christian, David O. Hodge, Raymond J Gibbons

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background. Patients with ischemic electrocardiographic (ECG) findings during exercise stress testing but normal perfusion images generally have a low risk of cardiac death or myocardial infarction (<1% per year). During vasodilator stress testing, however, the prognostic significance of the combination of normal perfusion images and ischemic ECG changes is unknown. Methods and results. Among 5526 patients who underwent vasodilator stress single photon emission computed tomography (SPECT), 49 (0.9%) had normal images but ischemic ECG changes. A unique feature of this population was that 43 (88%) were women with a mean age of 67 ± 10 years. Ischemic ECG changes occurred at a mean heart rate of 101 ± 15 beats per minute and persisted for 6.8 ± 4.7 minutes after termination of drug infusion. During follow-up of 28 ± 20 months, cardiac death occurred in 2 patients and nonfatal myocardial infarction in 4 patients. The rate of cardiac death or nonfatal myocardial infarction was 4% at 1 year, 10% at 2 years, and 14% at 3 years. Of the 12 patients who underwent coronary angiography or autopsy during follow-up, 11 had multivessel coronary artery disease, indicating that these patients likely had false-negative SPECT image results. Eight patients required coronary revascularization. Conclusions. The finding of ischemic ECG changes with normal SPECT images during vasodilator infusion is uncommon, occurs primarily in older women, and is associated with a higher subsequent cardiac event rate than is customarily associated with normal images.

Original languageEnglish (US)
Pages (from-to)4-8
Number of pages5
JournalJournal of Nuclear Cardiology
Volume10
Issue number1
DOIs
StatePublished - Jan 2003

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Single-Photon Emission-Computed Tomography
Vasodilator Agents
Myocardial Infarction
Perfusion
Coronary Angiography
Coronary Artery Disease
Autopsy
Heart Rate
Exercise
Pharmaceutical Preparations
Population

Keywords

  • Computed tomography
  • Electrocardiography
  • Prognosis
  • Single photon emission
  • Vasodilator stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic significance of ischemic electrocardiographic changes during vasodilator stress testing in patients with normal SPECT images. / Klodas, Elizabeth; Miller, Todd D.; Christian, Timothy F.; Hodge, David O.; Gibbons, Raymond J.

In: Journal of Nuclear Cardiology, Vol. 10, No. 1, 01.2003, p. 4-8.

Research output: Contribution to journalArticle

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N2 - Background. Patients with ischemic electrocardiographic (ECG) findings during exercise stress testing but normal perfusion images generally have a low risk of cardiac death or myocardial infarction (<1% per year). During vasodilator stress testing, however, the prognostic significance of the combination of normal perfusion images and ischemic ECG changes is unknown. Methods and results. Among 5526 patients who underwent vasodilator stress single photon emission computed tomography (SPECT), 49 (0.9%) had normal images but ischemic ECG changes. A unique feature of this population was that 43 (88%) were women with a mean age of 67 ± 10 years. Ischemic ECG changes occurred at a mean heart rate of 101 ± 15 beats per minute and persisted for 6.8 ± 4.7 minutes after termination of drug infusion. During follow-up of 28 ± 20 months, cardiac death occurred in 2 patients and nonfatal myocardial infarction in 4 patients. The rate of cardiac death or nonfatal myocardial infarction was 4% at 1 year, 10% at 2 years, and 14% at 3 years. Of the 12 patients who underwent coronary angiography or autopsy during follow-up, 11 had multivessel coronary artery disease, indicating that these patients likely had false-negative SPECT image results. Eight patients required coronary revascularization. Conclusions. The finding of ischemic ECG changes with normal SPECT images during vasodilator infusion is uncommon, occurs primarily in older women, and is associated with a higher subsequent cardiac event rate than is customarily associated with normal images.

AB - Background. Patients with ischemic electrocardiographic (ECG) findings during exercise stress testing but normal perfusion images generally have a low risk of cardiac death or myocardial infarction (<1% per year). During vasodilator stress testing, however, the prognostic significance of the combination of normal perfusion images and ischemic ECG changes is unknown. Methods and results. Among 5526 patients who underwent vasodilator stress single photon emission computed tomography (SPECT), 49 (0.9%) had normal images but ischemic ECG changes. A unique feature of this population was that 43 (88%) were women with a mean age of 67 ± 10 years. Ischemic ECG changes occurred at a mean heart rate of 101 ± 15 beats per minute and persisted for 6.8 ± 4.7 minutes after termination of drug infusion. During follow-up of 28 ± 20 months, cardiac death occurred in 2 patients and nonfatal myocardial infarction in 4 patients. The rate of cardiac death or nonfatal myocardial infarction was 4% at 1 year, 10% at 2 years, and 14% at 3 years. Of the 12 patients who underwent coronary angiography or autopsy during follow-up, 11 had multivessel coronary artery disease, indicating that these patients likely had false-negative SPECT image results. Eight patients required coronary revascularization. Conclusions. The finding of ischemic ECG changes with normal SPECT images during vasodilator infusion is uncommon, occurs primarily in older women, and is associated with a higher subsequent cardiac event rate than is customarily associated with normal images.

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