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Titolo:
Safety, hemodynamic profile, and feasibility of dobutamine stress technetium myocardial perfusion single-photon emission CT imaging for evaluation ofcoronary artery disease in the elderly
Autore:
Elhendy, A; van Domburg, RT; Bax, JJ; Valkema, R; Reijs, AEM; Krenning, EP; Roelandt, JRTC;
Indirizzi:
Erasmus Univ, Thoraxctr, NL-3015 GD Rotterdam, Netherlands Erasmus Univ Rotterdam Netherlands NL-3015 GD GD Rotterdam, Netherlands Univ Hosp Rotterdam Dijkzigt, Dept Nucl Med, Rotterdam, Netherlands Univ Hosp Rotterdam Dijkzigt Rotterdam Netherlands tterdam, Netherlands
Titolo Testata:
CHEST
fascicolo: 3, volume: 117, anno: 2000,
pagine: 649 - 656
SICI:
0012-3692(200003)117:3<649:SHPAFO>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
PROGNOSTIC VALUE; ECHOCARDIOGRAPHY; EXERCISE; AGE; RESPONSIVENESS; SCINTIGRAPHY; STIMULATION; HYPOTENSION; TOMOGRAPHY; ACCURACY;
Keywords:
arrhythmias; coronary artery disease; dobutamine; elderly; myocardial perfusion; safety;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Elhendy, A Erasmus Univ, Thoraxctr, Ba 302,Dr Molewaterplein 40, NL-3015 GD Rotterdam, Netherlands Erasmus Univ Ba 302,Dr Molewaterplein 40 Rotterdam Netherlands NL-3015 GD
Citazione:
A. Elhendy et al., "Safety, hemodynamic profile, and feasibility of dobutamine stress technetium myocardial perfusion single-photon emission CT imaging for evaluation ofcoronary artery disease in the elderly", CHEST, 117(3), 2000, pp. 649-656

Abstract

Objectives: Cardiovascular disease is the leading cause of morbidity and mortality in the elderly, The evaluation of coronary artery disease by exercise stress testing is frequently limited by the patient's inability to exercise, Although pharmacologic stress testing with dobutamine is an alternative, the safety of dobutamine myocardial perfusion scintigraphy in the elderly has not been previously studied. Patients and methods: We studied the safety and feasibility of dobutamine (up to 40 mu g/kg/min)atropine (up to 1 mg) stress myocardial perfusion scintigraphy using technetium single-photon emission CT imaging in 227 patients greater than or equal to 70 years old (mean +/- SD age,75 +/- 4 years). Acontrol group of 227 patients < 70 years old (mean age, 55 +/- 11 years; matched for gender, prevalence of previous infarction, beta-blocker therapy,and severity of resting perfusion abnormalities) was studied to assess age-related differences in the safety and the hemodynamic response, A feasibletest was defined as the achievement of the target heart rate and/or an ischemic end point (angina, ST-segment depression, or reversible perfusion abnormalities). Results: No myocardial infarction or death occurred during the test. The target heart rate was achieved more frequently in the elderly patients (87% vs 79%; p < 0.05), The elderly patients had a higher prevalence of supraventricular tachycardia (7% vs 1%; p < 0.005) and premature ventricular contraction (74% vs 32%; p < 0.005) during the test, as compared to the younger patients, There was a trend to a higher prevalence of ventricular tachycardia (5% vs 2%) and atrial fibrillation (38 vs 0.4%) in the elderly patients, Arrythmias were terminated spontaneously by termination of dobutamine infusion or by administration of metoprolol, Independent predictors of supraventricular tachyarrhthmias and ventricular tachycardia were older age (p < 0.001; chi(2), 9.8) and myocardial perfusion defect score at rest (p < 0.01; chi(2), 6.8) respectively, by using a multivariate analysis of clinical and stress test variables. Elderly patients had a higher prevalence of systolicBP drop > 20 mm Hg during the test (37% vs 12%; p < 0.05), The test was terminated due to hypotension in 2% of the elderly patients and in 1% of the control group. Age was the most powerful predictor of hypotension (p < 0.005; chi(2), 10.3). The test was considered feasible in 216 elderly patients (95%) and in 209 patients of the control group (92%). Conclusion: Dobutamine-atropine stress myocardial perfusion scintigraphy is a highly feasible method for the evaluation of coronary artery disease inthe elderly. Elderly patients have a higher risk for developing hypotension and supraventricular tachyarrhythmias during a dobutamine stress test. However, dobutamine-induced hypotension is often asymptomatic and rarely necessitates the termination of the test.

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Documento generato il 27/01/20 alle ore 16:58:17