Exercise myocardial perfusion scintigraphy is useful for evaluating myocardial ischemia even in the elderly

Pharmacologic stress testing is recommended to elderly patients as a valuab le alternative to exercise testing. We examined whether exercise testing is as useful for evaluating myocardial ischemia in the elderly as in the youn g. The consecutive 1,508 patients who underwent exercise Tl-201 single-phot on emission computed tomography (SPECT) were divided into six age groups: 6 -29 years (n = 56), 30-44 (n = 143), 45-54 (n = 311), 55-64 (n = 498), 65-7 4 (n = 402), and 75-88 (n = 98). Both heart rate and rate-pressure product at peak exercise were significantly lower in patients aged 75-88 than in th e other five groups. The frequency of ischemic ST depression was higher in patients aged 75-88 than in those aged 6-74, although the difference was no t significant. Moreover, the frequency of Tl-201 transient defect was signi ficantly higher in patients aged 75-88 than in those aged 6-74. On the othe r hand, the sensitivity of ischemic ST depression for Tl-201 transient defe ct was similar among the six groups, but the specificity was significantly lower in patients aged 75-88 than in those aged 6-74. In conclusion, exerci se Tl-201 SPECT is useful for evaluating myocardial ischemia even in the el derly, but exercise electrocardiography has limitations such as lower speci ficity in the elderly than Tl-201 SPECT.