Seguimiento clínico en pacientes con buena capacidad metabólica en la prueba de esfuerzo con SPECT miocárdico.

Javiera González, Hernán Prat, Eduardo Swett, Isabel Berrocal, René Fernández, Juan Pablo Zhindon, Ariel Castro, Teresa Massardo

Resumen


Background: The evaluation of coronary artery disease (CAD) can be performed with stress test and myocardial SPECT tomography. Aim: To assess the predictive value of myocardial SPECT using stress test for cardiovascular events in patients with good exercise capacity. Material and methods: We included 102 males aged 56 ± 10 years and 19 females aged 52 ± 10 years, all able to achieve 10 METs and ?85% of the theoretical maximum heart rate and at least 8 min in their stress test with gated 99mTc-sestamibi SPECT. Eighty two percent of patients were followed clinically for 33±17 months. Results: Sixty seven percent of patients were studied for CAD screening and the rest for known disease assessment. Treadmill stress test was negative in 75.4%; 37% of patients with moderate to severe Duke Score presented ischemia. Normal myocardial perfusion SPECT was observed in 70.2%. Reversible defects appeared in 24.8% of cases, which were of moderate or severe degree (>10% left ventricular extension) in 56.6%. Only seven cases had coronary events after the SPECT. Two major (myocardial infarction and emergency coronary revascularization) and 5 minor events (elective revascularization) ere observed in the follow-up. In a multivariate analysis, SPECT ischemia was the only statistically significant parameter that increased the probability of having a major or minor event. Conclusions: Nearly a quarter of our patients with good exercise capacity demonstrated reversible defects in their myocardial perfusion SPECT. In the intermediate-term follow-up, a low rate of cardiac events was observed, being the isotopic ischemia the only significant predictive parameter.

Palabras clave


Coronary artery disease; Exercise test; Technetium Tc 99m Sestamibi; Tomography, emission-computed, single photon

Texto completo:

PDF FINAL