technetium-tc-99m-tetrofosmin and Hypertension

There are currently insufficient data to indicate a role for stress myocardial perfusion imaging as a prognostic tool in hypertensive patients.. To assess the incremental value of stress myocardial perfusion imaging for the prediction of cardiac death in hypertensive patients relative to clinical data.. We studied 601 hypertensive patients (aged 59 +/- 10 years, 387 men) who underwent exercise bicycle or dobutamine (up to 40 microg/kg per min) stress technetium-99m tetrofosmin single photon emission computed tomography (SPECT) for evaluation of coronary artery disease.. 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.. 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.

Topics: Adrenergic beta-Agonists; Aged; Coronary Artery Disease; Death; Dobutamine; Exercise Test; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Cardiology; Chest Pain; Diabetes Mellitus, Type 2; Esophageal Neoplasms; Esophagectomy; Gastroesophageal Reflux; Humans; Hyperlipidemias; Hypertension; Male; Microcirculation; Organophosphorus Compounds; Organotechnetium Compounds; Risk Factors; Single Photon Emission Computed Tomography Computed Tomography; Stroke; Technetium Tc 99m Sestamibi

Systemic arterial hypertension is a strong and prevalent cardiovascular risk factor. Currently, information on the very long-term prognostic value of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in patients with systemic arterial hypertension is lacking. The aim of this study was to assess the value of stress (99m)Tc-tetrofosmin MPI for the prediction of very long-term outcome in these patients.. The study population consisted of 608 patients with systemic arterial hypertension who underwent exercise or dobutamine stress (99m)Tc-tetrofosmin MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 600 (99%) patients. The endpoints were all-cause mortality, cardiac death, nonfatal infarction, and coronary revascularization. Kaplan-Meier survival cures were constructed and univariate and multivariate analyses were performed to identify predictors of very long-term outcome.. The mean age of the patients was 59 ± 10 years, and 65% of them were male. MPI findings were normal in 301 patients (50%). Myocardial perfusion abnormalities were fixed in 162 (27%) and reversible in 137 (23%) patients. During a median 8.1-year follow-up, 241 (40%) patients died (121 cardiac deaths), 52 (9%) had a nonfatal myocardial infarction, and 128 (21%) underwent coronary revascularization. Survival curves in patients with a low vs a high summed difference score diverged up to 5 years after the test was performed. Multivariate analyses demonstrated that SPECT MPI provided incremental prognostic information up to 5 years after the test.. Stress (99m)Tc-tetrofosmin MPI provides incremental prognostic information for the prediction of cardiovascular outcome in patients with systemic arterial hypertension. Patients with normal stress MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the test is performed.

Topics: Aged; Cohort Studies; Exercise Test; Female; Humans; Hypertension; Male; Middle Aged; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Risk Factors; Tomography, Emission-Computed, Single-Photon

The prognostic value of ECG-gated rest 201Tl/stress 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of acute coronary syndrome (ACS: myocardial infarction (MI) and unstable angina (UA)) and the implications of ejection fraction (EF) has not yet been defined in Japanese.. The 1,895 patients were followed up for the occurrence ACS. The mean follow-up interval was 26.9+/-15.5 months. The 142 patients with revascularization within 60 days were censored. Summed stress score (SSS) and summed difference score (SDS) were calculated. The 19 MI and 29 UA occurred (1.1% and 1.6%, respectively). Univariate Cox analysis showed that hypertension (Wald 5.09, p<0.05), poststress EF (Wald 10.9, p<0.01), SSS (Wald 12.4, p<0.001) and SDS (Wald 18.7, p<0.001) were significant predictors of ACS. Multivariate Cox analysis showed that hypertension (Wald 4.27, p<0.05) and SDS (Wald 8.59, p<0.01) were independent predictors. When multiple clinical risk factors (number of coronary risk factors > or =2), significant ischemia (SDS > or =4) and low EF (EF <45%) were applied to multivariate Cox analysis, the combination of significant ischemia and low EF showed the highest predictive value (Wald 11.9; p<0.001) for future ACS.. Poststress EF added incremental prognostic value for the prediction of ACS.

Topics: Acute Coronary Syndrome; Adenosine Triphosphate; Aged; Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; Coronary Artery Disease; Coronary Circulation; Exercise Test; Female; Humans; Hypertension; Japan; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Myocardial Ischemia; Myocardial Perfusion Imaging; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Radiopharmaceuticals; Risk Assessment; Risk Factors; Stroke Volume; Thallium Radioisotopes; Time Factors; Treatment Outcome

Left ventricular mass (LVM) as assessed by magnetic resonance imaging (MRI, LVM(MRI)) and electrocardiographic (ECG) voltage reflect different pathological features. We hypothesized that ECG voltage is related to the electrical potential of cardiac muscle cells (electrical LVM) and to anatomical LVM as evaluated by MRI, and that the divergence between electrical LVM and anatomical LVM reflects the degree of myocardial damage. Because adipose tissue has high electrical resistance, we previously found a very strong correlation between body-fat-corrected mean ECG voltage (Vfm) and LVM as estimated by echocardiography in patients with essential hypertension. In this study we compared LVM(MRI), Vfm, the ratio of Vfm x 10(2)/LVM(MRI), and the results of 99mTc tetrofosmin scintigraphy in patients with and without myocardial infarction (MI). We studied 33 patients without Ml and 26 patients with Ml. Vfm significantly correlated with LVM(MRI) in patients without MI (r=0.71, p<0.01). The ratio of Vfm x 10(2)/LVM(MRI) apparently reflected the relation between electrical LVM and anatomical LVM. Vfm x 10(2)/LVM(MRI) in patients with MI was smaller than that in patients without MI (0.98+/-0.28 vs. 1.42+/-0.29, p<0.01). Vfm x 10(2)/LVM(MRI) decreased as 99mTc score increased (r=-0.66, p<0.01). Our results indicate that Vfm is a useful index of electrical LVM and that Vfm x 10(2)LVM(MRI) reflects the electrical potential of the viable myocardium in total anatomical LVM.

Topics: Aged; Electrocardiography; Female; Heart; Humans; Hypertension; Hypertrophy, Left Ventricular; Magnetic Resonance Imaging; Male; Middle Aged; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Reference Values; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Hypertensive patients with complete left bundle branch block who experience chest pain present special problems in the radionuclide diagnosis of coronary artery disease (CAD). The aim of this study was to assess the utility of Tc-99m tetrofosmin SPECT for the diagnosis of CAD in 35 hypertensive patients with left bundle branch block hospitalized for chest pain.. Images were analyzed semiquantitatively for the presence of both fixed or reversible perfusion defects (method A) or only reversible defects (method B) in the distribution of the left anterior descending artery (LAD) territory. Perfusion defects observed in the territory of any other coronary artery were always considered. Thirty-five patients without infarction underwent adenosine Tc-99m tetrofosmin SPECT, transthoracic echocardiography, and coronary angiography.. The mean left ventricular ejection fraction was calculated as 39.9% +/- 11.6%, and the prevalence of CAD was 29%. The sensitivity of SPECT was identical for the two methods at 89%. The specificity increased 19% with method A and 54% with method B. The positive predictive value remained unsatisfactorily low with both methods (27% for method A and 40% for method B), and the negative predictive value improved from 83% with method A to 93% with method B.. Only reversible perfusion defects in the LAD territory should be considered significant for CAD, and these patients should undergo coronary angiography. Reversible or fixed perfusion defects in the left circumflex and right coronary artery territories should be evaluated according to other clinical parameters (global left ventricular ejection fraction, extension of perfusion defects). The highly negative predictive value of adenosine SPECT could help in the exclusion of CAD.

Topics: Adenosine; Bundle-Branch Block; Chest Pain; Coronary Angiography; Coronary Artery Disease; Echocardiography; Female; Heart Septal Defects; Humans; Hypertension; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Stress, Physiological; Tomography, Emission-Computed, Single-Photon