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

Javiera Gonzalez; Hernán Prat; Eduardo Swett; Isabel Berrocal; René Fernández; Juan P Zhindon; Ariel Castro; Teresa Massardo

Ayuda

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

Javiera González ^[1] ; Hernán Prat ^[1] ; Eduardo Swett ^[1] ; Isabel Berrocal ^[1] ; René Fernández ^[1] ; Juan Pablo Zhindon ^[1] ; Ariel Castro ^[1] ; Teresa Massardo ^[1]
1. [1] Universidad de Chile
  
  Universidad de Chile
  
  Santiago, Chile
Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 143, Nº. 11, 2015, págs. 1426-1434
Idioma: español
Títulos paralelos:
- Follow-up of patients with good exercise capacity in stress test with myocardial single-photon emission computed tomography (SPECT)
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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.