Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Adenosine-stress myocardial perfusion imaging in octogenarians: Safety, tolerability and long-term prognostic implications of hemodynamic response and SPECT related variables Athanasios Katsikis MD,PhD, Athanasios Theodorakos MD, Spyridon Papaioannou MD,PhD, Antonios Kalkinis MD,PhD, Genovefa Kolovou MD,PhD, Konstantinos Konstantinou MD, Maria Koutelou MD,PhD Onassis Cardiac Surgery Center, Nuclear Medicine Department Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology AIM & BACKGROUND Evaluation of tolerability, safety and prognostic implications of adenosine-stress myocardial perfusion imaging (MPI) in octogenarians. ageing of the population will become a virtually universal phenomenon during the 21st century. the elderly for the new millennium should be defined as patients ≥75 years in these “older old” patients, data regarding side effects and long-term prognostic role of adenosine-stress SPECT-MPI remain limited. Copyright American Society of Nuclear Cardiology

METHODS Single centre, cohort study with prospective follow-up. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Single centre, cohort study with prospective follow-up. 370 patients with age 80-89 years undergoing MPI with adenosine-stress in conjunction with 201Tl or 99mTc known LVEF determined by echocardiography (median 55%) 49% with history of myocardial infarction (MI) or revascularization excluded if MI within 15 days or significant valvular, congenital and non-ischemic cardiomyopathic disease. End-points: All-cause death (ACD), cardiac death (CD), CD/MI, CD,MI or late (>90 days) revascularization, safety & tolerability of adenosine infusion. Variables evaluated: SSS, SDS, SRS, TID, lung uptake, LVEF, hemodynamic & clinical variables. Copyright American Society of Nuclear Cardiology

Incremental prognostic value Independent prognostic value Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Incremental prognostic value Independent prognostic value Global Chi2 values of the multivariate models for each end-point. Hemodynamic variables included ΔHR ≤+10bpm for ACD and "Non SBP dippers & tachycardics" for the rest of the endpoints. All stepwise increases in global Chi2 from Model 1 to Model 5 were significant at p<0.05 for all endpoints with the exceptions of change from Model 1 to Model 2 for the CD or MI and CD,MI or late revascularization endpoints. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Kaplan-Meier plots of estimated 10-year survival free of adverse events by SSS-based risk groups Copyright American Society of Nuclear Cardiology

CONCLUSIONS Adenosine-stress MPI in octogenarians is: Feasible Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS Adenosine-stress MPI in octogenarians is: Feasible Safe (no deaths, MI, sustained VT) Relatively well tolerated 16% premature discontinuation rate, 99% tolerated >3 minutes infusion Very effective for long-term risk stratification through both scintigraphic and hemodynamic response variables, regardless of baseline LVEF. Copyright American Society of Nuclear Cardiology