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Journal of Nuclear Cardiology

, Volume 26, Issue 1, pp 250–262 | Cite as

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

  • Athanasios KatsikisEmail author
  • Athanasios Theodorakos
  • Spyridon Papaioannou
  • Antonios Kalkinis
  • Genovefa Kolovou
  • Konstantinos Konstantinou
  • Maria Koutelou
Original Article

Abstract

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.

Keywords

Octogenarians adenosine myocardial perfusion imaging risk stratification safety 

Abbreviations

MPI

Myocardial perfusion imaging

SBP

Systolic blood pressure

HR

Heart rate

SSS

Summed stress score

SRS

Summed rest score

SDS

Summed difference score

TID

Transient ischemic left ventricular dilation

LHR

Lung to heart ratio

ACD

All-cause death

CD

Cardiac death

Notes

Disclosures

No conflicts of interest to disclose.

Supplementary material

12350_2017_893_MOESM1_ESM.pptx (2.2 mb)
Supplementary material 1 (PPTX 2266 kb)

References

  1. 1.
    Bourque JM, Beller GA. Stress myocardial perfusion imaging for assessing prognosis: An update. JACC Cardiovasc Imaging. 2011;4:1305-19.Google Scholar
  2. 2.
    Johnston DL, Daley JR, Hodge DO, Hopfenspirger MR, Gibbons RJ. Hemodynamic responses and adverse effects associated with adenosine and dipyridamole pharmacologic stress testing: A comparison in 2,000 patients. Mayo Clin Proc. 1995;70:331-6.Google Scholar
  3. 3.
    Alkoutami GS, Reeves WC, Movahed A. The safety of adenosine pharmacologic stress testing in patients with first-degree atrioventricular block in the presence and absence of atrioventricular blocking medications. J Nucl Cardiol. 1999;6:495-7.Google Scholar
  4. 4.
    Samuels B, Kiat H, Friedman JD, Berman DS. Adenosine pharmacologic stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis. Diagnostic efficacy and comparison of clinical, hemodynamic and electrocardiographic variables with 100 age-matched control subjects. J Am Coll Cardiol. 1995;25:99-106.Google Scholar
  5. 5.
    Reyes E, Loong CY, Wechalekar K, Latus K, Anagnostopoulos C, Underwood SR. Side effect profile and tolerability of adenosine myocardial perfusion scintigraphy in patients with mild asthma or chronic obstructive pulmonary disease. J Nucl Cardiol. 2007;14:827-34.Google Scholar
  6. 6.
    Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging: Results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol. 1994;23:384-9.Google Scholar
  7. 7.
    Department of Economic and Social Affairs, Population Division. World population ageing report 2013.Google Scholar
  8. 8.
    Katsikis A, Theodorakos A, Papaioannou S, Tsapaki V, Kolovou G, Drosatos A, et al. Long-term prognostic value of myocardial perfusion imaging in octogenarians able to undergo treadmill exercise stress testing. J Nucl Cardiol. 2014;21:1213-22.Google Scholar
  9. 9.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57-185.Google Scholar
  10. 10.
    Henzlova MJ, Cerqueira MD, Mahmarian JJ, Yao SS. Stress protocols and tracers. J Nucl Cardiol. 2006;13:e80-90.Google Scholar
  11. 11.
    Abidov A, Hachamovitch R, Hayes SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients older than age 55 years undergoing vasodilator stress myocardial perfusion study. Circulation. 2003;107:2894-9.Google Scholar
  12. 12.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2016 Update: A report from the American Heart Association. Circulation. 2016;133:e38-360.Google Scholar
  13. 13.
    Yao Z, Zhu H, Li W, Chen C, Wang H, Shi L, et al. Adenosine triphosphate stress myocardial perfusion imaging for risk stratification of patients aged 70 years and older with suspected coronary artery disease. J Nucl Cardiol 2016. doi: 10.1007/s12350-015-0355-5.Google Scholar
  14. 14.
    Gnanasegaran GBJ, Malcolm M, Rossiter A, McCool D, Hilson AJW. Safety and tolerability of adenosine stress myocardial perfusion scintigraphy in the evaluation of coronary artery disease in the elderly patients—A case control study. World J Nucl Med. 2006;5:3-8.Google Scholar
  15. 15.
    Anthopoulos LP, Bonou MS, Kardaras FG, Sioras EP, Kardara DN, Sideris AM, et al. Stress echocardiography in elderly patients with coronary artery disease: Applicability, safety and prognostic value of dobutamine and adenosine echocardiography in elderly patients. J Am Coll Cardiol. 1996;28:52-9.Google Scholar
  16. 16.
    Hashimoto A, Palmar EL, Scott JA, Abraham SA, Fischman AJ, Force TL, et al. Complications of exercise and pharmacologic stress tests: Differences in younger and elderly patients. J Nucl Cardiol. 1999;6:612-9.Google Scholar
  17. 17.
    Alkoutami GS, Reeves WC, Movahed A. The frequency of atrioventricular block during adenosine stress testing in young, middle-aged, young-old, and old-old adults. Am J Geriatr Cardiol. 2001;10:159-61.Google Scholar
  18. 18.
    Iskandrian AS. Adenosine myocardial perfusion imaging. J Nucl Med. 1994;35:734-6.Google Scholar
  19. 19.
    Hachamovitch R, Kang X, Amanullah AM, Abidov A, Hayes SW, Friedman JD, et al. Prognostic implications of myocardial perfusion single-photon emission computed tomography in the elderly. Circulation. 2009;120:2197-206.Google Scholar
  20. 20.
    Curtis JP, Ko DT, Wang Y, Wackers FJ, Foody JM. The prognostic value of vasodilator myocardial perfusion imaging in octogenarians. Am J Geriatr Cardiol. 2004;13:239-45.Google Scholar
  21. 21.
    Nair SU, Ahlberg AW, Mathur S, Katten DM, Polk DM, Heller GV. The clinical value of single photon emission computed tomography myocardial perfusion imaging in cardiac risk stratification of very elderly patients (>/=80 years) with suspected coronary artery disease. J Nucl Cardiol. 2012;19:244-55.Google Scholar
  22. 22.
    Garzillo CL, Hueb W, Gersh BJ, Lima EG, Rezende PC, Hueb AC, et al. Long-term analysis of left ventricular ejection fraction in patients with stable multivessel coronary disease undergoing medicine, angioplasty or surgery: 10-Year follow-up of the MASS II trial. Eur Heart J. 2013;34:3370-7.Google Scholar
  23. 23.
    Hachamovitch R. Clinical value of combined perfusion and function imaging in the diagnosis, prognosis, and management of patients with suspected or known coronary artery disease. In: Clinical gated cardiac SPECT, 2nd ed. Oxford: Blackwell Publishing; 2006.Google Scholar
  24. 24.
    Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900-7.Google Scholar
  25. 25.
    Hachamovitch R, Rozanski A, Shaw LJ, Stone GW, Thomson LE, Friedman JD, et al. Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011;32:1012-24.Google Scholar
  26. 26.
    Bajaj NS, Singh S, Farag A, El-Hajj S, Heo J, Iskandrian AE, et al. The prognostic value of non-perfusion variables obtained during vasodilator stress myocardial perfusion imaging. J Nucl Cardiol. 2016;23:390-413.Google Scholar
  27. 27.
    Giubbini R, Campini R, Milan E, Zoccarato O, Orlandi C, Rossini P, et al. Evaluation of technetium-99m-sestamibi lung uptake: Correlation with left ventricular function. J Nucl Med. 1995;36:58-63.Google Scholar
  28. 28.
    Kumar SP, Brewington SD, O’Brien KF, Movahed A. Clinical correlation between increased lung to heart ratio of technetium-99m sestamibi and multivessel coronary artery disease. Int J Cardiol. 2005;101:219-22.Google Scholar
  29. 29.
    Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy. J Am Coll Cardiol. 2005;45:722-9.Google Scholar
  30. 30.
    Amanullah AM, Berman DS, Kiat H, Friedman JD. Usefulness of hemodynamic changes during adenosine infusion in predicting the diagnostic accuracy of adenosine technetium-99m sestamibi single-photon emission computed tomography (SPECT). Am J Cardiol. 1997;79:1319-22.Google Scholar
  31. 31.
    Witbrodt BC, Kelkar A, Shaw L, Sandesara P, Dorbala S, Chow B, et al. Prognostic significance of resting blood pressure and blood pressure response during vasodilator stress Rb-82 positron emission tomography myocardial perfusion imaging. J Am Coll Cardiol 2015;65:A1147.Google Scholar
  32. 32.
    Hage FG, Iskandrian AE. Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications. J Nucl Cardiol. 2010;17:536-9.Google Scholar
  33. 33.
    Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710-8.Google Scholar
  34. 34.
    Tadamura E, Kudoh T, Motooka M, Inubushi M, Shirakawa S, Hattori N, et al. Assessment of regional and global left ventricular function by reinjection T1-201 and rest Tc-99m sestamibi ECG-gated SPECT: Comparison with three-dimensional magnetic resonance imaging. J Am Coll Cardiol. 1999;33:991-7.Google Scholar
  35. 35.
    Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 Revision. Eur J Nucl Med Mol Imaging. 2015;42:1929-40.Google Scholar
  36. 36.
    Botvinick EH, Costouros NG, Bacharach SL, O’Connell \JW. Assessment of cardiac function: First-pass, equilibrium blood pool, and gated myocardial SPECT. In: Dilsizian V, Narula J, editors. Atlas of nuclear cardiology. 4th ed. New York: Springer; 2013.Google Scholar

Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Athanasios Katsikis
    • 1
    • 3
    • 5
    Email author
  • Athanasios Theodorakos
    • 1
  • Spyridon Papaioannou
    • 1
  • Antonios Kalkinis
    • 1
  • Genovefa Kolovou
    • 2
  • Konstantinos Konstantinou
    • 3
    • 4
  • Maria Koutelou
    • 1
  1. 1.Nuclear Medicine DepartmentOnassis Cardiac Surgery CenterAthensGreece
  2. 2.Cardiology DepartmentOnassis Cardiac Surgery CenterAthensGreece
  3. 3.Cardiology Department401 General Military Hospital of AthensAthensGreece
  4. 4.Cardiology DepartmentIpokration Hospital of AthensAthensGreece
  5. 5.AthensGreece

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