ORIGINAL ARTICLES Incidence and predictors of heart failure during long-term follow-up after stress Tc-99m sestamibi tomography in patients with suspected coronary artery disease

Background. Heart failure is a major cause of morbidity and death in patients with coronary artery disease (CAD). The aim of this study was to define the incidence and predictors of heart failure during long-term follow-up in patients with suspected CAD referred for stress myocardial perfusion imaging. Methods and Results. We studied 787 patients (mean age, 57 12 years; 470 men) with suspected CAD who had no history of previous myocardial infarction or heart failure with exercise (n 508) or dobutamine (n 279) stress technetium 99m sestamibi single photon emission computed tomography. Patients were followed up for the occurrence of heart failure, nonfatal myocardial infarction, and death. An abnormal perfusion scan (reversible or fixed perfusion defect) was detected in 341 patients (43%). During a mean follow-up of 6.7 2.3 years, heart failure occurred in 46 patients (6%), 170 patients (22%) died, and 52 patients (7%) had nonfatal myocardial infarction. Patients in whom heart failure developed were older (mean age, 60 12 years vs 56 12 years; P .01) and were more likely to be men (34 [74%] vs 436 [59%], P .01) and to have an abnormal scan (32 [70%] vs 309 [42%], P .0002) compared with patients without heart failure. Nonfatal myocardial infarction occurred before the onset of heart failure in only 3 patients (7%). By multivariate analysis, predictors of heart failure were age (risk ratio [RR], 1.04 [95% CI, 1.01-1.08]), male gender (RR, 2 [95% CI, 1.3-4.5]), resting heart rate (RR, 1.1 [95% CI, 1.05-1.2]), and abnormal scan (RR, 2.3 [95% CI, 1.4-3.9]). The annual mortality rate was 15% after the diagnosis of heart failure. Conclusion. In patients with suspected CAD and no history of myocardial infarction, late heart failure is predicted by age, gender, resting heart rate, and abnormal perfusion, and it is associated with a substantial mortality rate. The majority of heart failure events are heralded by perfusion abnormalities on sestamibi single photon emission computed tomography but not by an earlier myocardial infarction. (J Nucl Cardiol 2004;11:527-33.)