Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests

Purpose To compare the long-term prognostic value of dobutamine stress echocardiography and dobutamine stress single photon emission computed tomography (SPECT) in patients unable to perform an exercise test. Methods We assessed the prognostic value of dobutamine stress technetium 99m (99mTc)-sestamibi SPECT and dobutamine stress echocardiography in 301 patients who were unable to perform exercise tests. Outcomes during a mean (± SD) follow-up of 7.3 ± 2.8 years were overall death, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization. Results Abnormal myocardial perfusion was detected in 66% of patients (n = 198), while 60% (n = 182) had an abnormal stress echocardiogram; agreement was 82% (κ = 0.62). During the follow-up period, 100 deaths (33%) occurred, of which 43% were due to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularization. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after a normal scan, and 2.6% for cardiac death and 6.5% for all cardiac events after an abnormal scan (P<0.0001). For stress echocardiography, annual event rates were 0.6% for cardiac death and 3.3% for all cardiac events after a normal test, and 2.8% for cardiac death and 6.9% for all cardiac events after an abnormal test (P<0.0001). Conclusion Dobutamine stress 99mTc-sestamibi SPECT and dobutamine stress echocardiography provide comparable long-term prognostic information in addition to that afforded by clinical data.