In a prospective epidemiologic follow-up study 1, 17 991 patients without known cardiomyopathy or valvular disease underwent myocardial-perfusion single-photon-emission computed tomography (SPECT) during stress and at rest. Patients were divided into five categories on the basis of their self-reported symptoms of chest pain and dyspnea at the time of testing (none, nonanginal chest pain, atypical angina, typical angina, and dyspnea). After a mean follow-up of 2.7 (SD±1.7) years, the rate of death from cardiac causes and from any cause was significantly higher among patients with dyspnea than among patients with other or no symptoms at presentation. Among patients with no known history of coronary artery disease, those with dyspnea had four times the risk of sudden death from cardiac causes of asymptomatic patients and more than twice the risk of patients with typical angina. Dyspnea remained an independent predictor of the risk of death from cardiac or any cause after adjustment for other significant factors.
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