Prediction of cardiac death in hypertensive patients with suspected or known coronary artery disease by stress technetium-99m tetrofosmin myocardial perfusion imaging

Background: There are currently insufficient data to indicate a role for stress myocardial perfusion imaging as a prognostic tool in hypertensive patients. Objectives: To assess the incremental value of stress myocardial perfusion imaging for the prediction of cardiac death in hypertensive patients relative to clinical data. Patients: We studied 601 hypertensive patients (aged 59 ± 10 years, 387 men) who underwent exercise bicycle or dobutamine (up to 40 μg/kg per min) stress technetium-99m tetrofosmin single photon emission computed tomography (SPECT) for evaluation of coronary artery disease. Outcome: Cardiac death during follow-up. Results: An abnormal scan (reversible or fixed perfusion abnormalities) was detected in 293 (49%) patients (134 had reversible abnormalities). During a mean follow-up period of 3.1 ± 1.3 years, 109 (18%) patients died; of whom, 42 patients (39%) died due to cardiac causes. Independent predictors of cardiac death were age [hazard ratio = 1.04, 95% confidence interval (CI) 1.01-1.08], history of previous myocardial infarction (hazard ratio = 2, CI 1.1-3.7), stress rate-pressure product (hazard ratio = 0.94, CI 0.87-0.98) and abnormal scan (hazard ratio = 4.7 CI 1.9-11.4). Both reversible and fixed abnormalities were predictive of death. The annual cardiac death rate was 5.3% in patients with an abnormal and 0.5% in patients with a normal perfusion scan. Conclusion: Stress technetium-99m tetrofosmin myocardial perfusion imaging provides prognostic information incremental to clinical data for the prediction of cardiac death in hypertensive patients with known or suspected coronary artery disease.

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