Key result
In patients with symptomatic heart failure, achieving less than 5 metabolic equivalents during stress testing was significantly associated with the occurrence of adverse cardiac events over 36 months (p=0.03).
Why the study?
Does stress-rest gated SPECT myocardial perfusion scintigraphy predict adverse cardiac events in patients with symptomatic heart failure?
Cohort (n=52)
No
Does stress-rest gated SPECT myocardial perfusion scintigraphy predict adverse cardiac events in patients with symptomatic heart failure?
p-value: p=0.03
In patients with symptomatic heart failure, poor functional capacity (<5 METs) during stress testing is significantly associated with adverse cardiac events at 3 years.
INTRODUCTION: Heart failure, primarily in the elderly, is a growing epidemic in today's world. It leads to high rates of disability and mortality, as well as significant health care expenditures, making it important to assess possible predictors of adverse cardiac events. In Cuba, heart failure mortality is 19.1/100,000 population. OBJECTIVES: Assess the value of stress-rest protocol gated-SPECT for identifying patients with symptomatic heart failure likely to suffer adverse cardiac events. METHODS: A study was conducted of 52 patients (mean age 59 years, SD 9; 62% women) with functional capacity II/III (New York Heart Association scale) and left ventricular ejection fraction <40%. Patients were divided into two groups based on coronary heart disease diagnosis: those with coronary heart disease (41), labeled ischemic; and those without (11), labeled nonischemic. All underwent gated SPECT myocardial perfusion scintigraphy with technetium-99m-labeled methoxyisobutyl isonitrile, using a two-day stress-rest protocol, including evaluation of intraventricular synchrony by phase analysis. Patients were followed over 36 months for adverse cardiac effects. RESULTS: No significant differences were observed between the two groups during the stress test with regard to exercise time, metabolic equivalents or percentage of maximal heart rate during maximal stress. Summed stress, rest and difference scores, however, were significantly different between the ischemic and nonischemic groups: 16.82 (SD 6.37) vs. 7.54 (SD 5.8), p <0.001; 14.43 (SD 6.28) vs. 6.45 (SD 3.77), p = 0.001; and 2.39 (SD 4.89) vs. 1.09 (SD 3.7), p = 0.034. No differences were found in ventricular function, although stress-minus-rest left ventricular ejection fraction was slightly lower in patients with ischemic heart disease (-1.29, SD 5.8) than in patients without ischemic heart disease (1.27, SD 4.31). Dyssynchrony was greater in patients with ischemic heart disease than in those without, primarily during stress (p <0.01). The only variable that showed a possible association with the occurrence of adverse events was <5 metabolic equivalents on the stress test (p = 0.03), while resting phase SD showed only a tendency toward association (p = 0.05). CONCLUSIONS: Information on myocardial perfusion, functional capacity and intraventricular synchrony obtained from stress-rest gated SPECT may help identify patients with symptomatic heart failure who are likely to develop adverse cardiac events, enabling better management of higher-risk cases and improved allocation of resources.
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Peix et al. (2015) conducted a cohort in Symptomatic heart failure (n=52). Exercise capacity <5 metabolic equivalents (METs) vs. Exercise capacity ≥5 METs was evaluated on Adverse cardiac events (heart failure progression, potentially lethal ventricular arrhythmia, death, myocardial revascularization, and acute coronary syndrome) (p=0.03). In patients with symptomatic heart failure, achieving less than 5 metabolic equivalents during stress testing was significantly associated with the occurrence of adverse cardiac events over 36 months (p=0.03).
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