Myocardial perfusion defects and coronary risk factors in symptomatic and asymptomatic elderly women

Background: We investigated the relation between risk factors of coronary artery disease (CAD) and myocardial ischemia detected by ²⁰¹Tl SPECT in elderly women. Methods: 306 women aged ≥75 yr (79.1 ± 3.6 yr) who underwent pharmacologic ²⁰¹Tl SPECT for suspected CAD based on symptoms or CAD risk factors were included. Coronary risk factors were evaluated by medical records, and included diabetes mellitus (DM), hypertension, hypercholesterolemia, cigarette smoking, greater age (≥80 yr), and obesity. Summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were calculated based on stress and redistribution SPECT images for semiquantification. Results: The symptomatic group (n = 110) had a 34.5% perfusion defect rate. The asymptomatic group (n = 196) had a significantly lower perfusion defect rate of 16.8%. However, this significantly increased to 29.4% and 22.0% in the presence of diabetes mellitus (DM) and hypertension, respectively. In addition, the summed stress score of asymptomatic patients (12.4 ± 6.0) was not lower but comparable to that of symptomatic patients (10.0 ± 6.0). Conclusions: In elderly women suspected of CAD, pharmacologic perfusion imaging can be used to identify myocardial ischemia in patients with angina as well as asymptomatic subjects with concurrent DM or hypertension.