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Increasing frequency of dyspnea among patients referred for cardiac stress testing

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Journal of Nuclear Cardiology Aims and scope

Abstract

Objective

To assess the frequency, change in prevalence, and prognostic significance of dyspnea among contemporary patients referred for cardiac stress testing.

Patients and methods

We evaluated the prevalence of dyspnea and its relationship to all-cause mortality among 33,564 patients undergoing stress/rest SPECT-MPI between January 1, 2002 and December 31, 2017. Dyspnea was assessed as a single-item question. Patients were divided into three temporal groups.

Results

The overall prevalence of dyspnea in our cohort was 30.2%. However, there was a stepwise increase in the temporal prevalence of dyspnea, which was present in 25.6% of patients studied between 2002 and 2006, 30.5% of patients studied between 2007 and 2011, and 38.7% of patients studied between 2012 and 2017. There was a temporal increase in the prevalence of dyspnea in each age, symptom, and risk factor subgroup. The adjusted hazard ratio for mortality was higher among patients with dyspnea vs those without dyspnea both among all patients, and within each chest pain subgroup.

Conclusions

Dyspnea has become increasingly prevalent among patients referred for cardiac stress testing and is now present among nearly two-fifths of contemporary cohorts referred for stress-rest SPECT-MPI. Prospective study is needed to standardize the assessment of dyspnea and evaluate the reasons for its increasing prevalence.

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Abbreviations

CAD:

Coronary artery disease

HFpEF:

Heart failure with preserved ejection fraction

LVEF:

Left ventricular ejection fraction

MPI:

Myocardial perfusion imaging

NDI:

National Death Index

SPECT:

Stress-rest single photon emission computed tomography

SSDI:

Social Security Death Index (SSI)

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Authors and Affiliations

  1. Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Alan Rozanski MD & Sakul Sakul MD

  2. Departments of Imaging and Medicine and Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Heidi Gransar MS, Donghee Han MD, Sean W. Hayes MD, John D. Friedman MD, Louise E. J. Thomson MBChB & Daniel S. Berman MD

  3. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada

    Robert J. H. Miller MD

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  1. Alan Rozanski MD
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  2. Heidi Gransar MS
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Correspondence to Alan Rozanski MD.

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Disclosures

Dr. Berman participates in software royalties for QPS software at Cedars-Sinai Medical Center. All the other authors have no disclosures.

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The work was supported in part by the Dr Miriam and Sheldon G. Adelson Medical Research Foundation.

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Rozanski, A., Gransar, H., Sakul, S. et al. Increasing frequency of dyspnea among patients referred for cardiac stress testing. J. Nucl. Cardiol. 30, 2303–2313 (2023). https://doi.org/10.1007/s12350-023-03375-4

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  • DOI: https://doi.org/10.1007/s12350-023-03375-4

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