Prognostic value of treadmill exercise and dobutamine stress positron emission tomography

Although positron emission tomography (PET) is routinely performed using vasodilator stress, exercise and dobutamine stress are available alternatives. Evidence suggests that vasodilator PET myocardial perfusion imaging (MPI) has prognostic value, but the prognostic value of treadmill exercise and dobutamine PET MPI is unknown.

To determine the potential prognostic value of nonvasodilator stress PET MPI.

Patients underwent treadmill exercise or dobutamine PET MPI. Images were assessed qualitatively and semiquantitatively. PET results were categorized as normal (summed stress score [SSS] of less than 4), abnormal (SSS of 4 or greater) or inconclusive (SSS of less than 4 and submaximal peak stress heart rate). Patient follow-up (cardiac death, nonfatal myocardial infarction [MI] and/or late revascularization) was performed.

Of the 124 patients (mean follow-up period of 2.3+/-1.6 years), 46 patients (37%) had a normal study, 15 patients (12%) had an inconclusive study and 63 (51%) had an abnormal PET. Patients with a normal PET had no deaths or nonfatal MI. One patient with a normal PET underwent late revascularization (annual event rate of 1.7%). Patients with an abnormal PET had 15 cardiac events (one cardiac death, four nonfatal MIs and 10 late revascularizations), with an annual event rate of 13.0% (P=0.002).

Although small, the present study suggests that defects seen on PET myocardial perfusion, resulting from stressors (treadmill exercise and dobutamine) that increase myocardial oxygen demand, may have prognostic value.