Published online before print April 4, 2005, doi: 10.1161/01.CIR.0000160862.36124.8E
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(Circulation. 2005;111:1771-1776.)
© 2005 American Heart Association, Inc.
Exercise Physiology |
Exercise Single-Photon Emission Computed Tomography Provides Effective Risk Stratification of Elderly Men and Elderly Women
From the Division of Cardiovascular Diseases and Department of Internal Medicine (U.S.V., T.D.M., R.J.G.) and the Department of Biostatistics (D.O.H.), Mayo Clinic, Rochester, Minn.
Correspondence to Todd D. Miller, MD, Mayo Clinic, Gonda 5 South, 200 First St SW, Rochester, MN 55905. E-mail miller.todd{at}mayo.edu
Received June 2, 2004; revision received December 23, 2004; accepted January 6, 2005.
Background— In a recent study, we reported that the Duke treadmill score was unable to effectively stratify elderly patients according to risk. The purpose of this study was to evaluate the prognostic value of exercise single-photon emission computed tomography (SPECT) in this same population and to examine results by gender.
Methods and Results— A cohort of 247 elderly (age 
75 years) patients (108 women, 139 men, age 77±3 years) who underwent exercise thallium-201 SPECT were followed up for a median duration of 6.4 years. SPECT variables were significantly associated with cardiac death: summed stress score (SSS) 
2=19.5, P<0.001; summed difference score 2=12.3, P<0.001; increased lung uptake 2=9.6, P=0.002; and left ventricular enlargement 2=8.3, P=0.004. The Duke score was not significantly associated with cardiac death (2<1, P=NS). The SSS classified most patients as low risk (49%) or high risk (35%); the Duke score classified the majority (68%) as intermediate risk. Annual cardiac mortality rates for patients categorized by SSS as low risk and high risk were 0.8% and 5.8%, respectively. Cardiac survival rates according to SSS risk categories were significantly different for both women (P=0.012) and men (P=0.003).
Conclusions— SPECT classified most elderly patients into clinically useful low- and high-risk categories and accurately predicted outcomes in both genders. If these results can be validated in future studies, exercise SPECT rather than standard treadmill testing may emerge as the initial noninvasive testing strategy in elderly patients who are able to exercise.
Key Words: aging • exercise • prognosis • radioisotopes • scintigraphy
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