Abstract
Background
Data on the prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) is limited and based on small cohorts.
Methods and Results
We conducted a single-center, retrospective cohort study of 10,275 consecutive patients who underwent regadenoson SPECT-MPI. Among the study subjects, 28.7% had abnormal MPI and 25.5% had myocardial ischemia. Patients were followed for a mean of 2.4 ± 2.2 years for major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. There was a significant stepwise increase in MACE with an increasing burden of perfusion abnormality (P < .001) and myocardial ischemia (P < .001). Abnormal MPI (adjusted HR 1.52; 95% CI 1.21 to 1.91) and myocardial ischemia (adjusted HR 1.53; 95% CI 1.25 to 1.89) were associated with MACE, independent of and incremental to clinical covariates and left ventricular ejection fraction (LVEF). Moreover, post-stress LVEF, LVEF reserve, and left ventricular end-diastolic volume added significant prognostic information. Transient ischemic dilation ≥ 1.31 did not provide incremental prognostic value (adjusted HR 1.02; P = .906).
Conclusion
In the largest cohort to date, we demonstrated that the presence and severity of perfusion abnormality and myocardial ischemia on regadenoson stress SPECT-MPI are associated with an independent increase in MACE.
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Abbreviations
- CAD:
-
Coronary artery disease
- CD:
-
Cardiac death
- CR:
-
Coronary revascularization
- ESRD:
-
End-stage renal disease
- IDI:
-
Integrated discrimination improvement
- LCR:
-
Late coronary revascularization
- LVEDV:
-
Left ventricular end-diastolic volume
- LVEF:
-
Left ventricular ejection fraction
- MACE:
-
Major adverse cardiac events
- MI:
-
Myocardial infarction
- MPI:
-
Myocardial perfusion imaging
- SDS:
-
Summed difference score
- SSS:
-
Summed stress score
- TID:
-
Transient ischemic dilation
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Disclosure
Dr. Doukky has received research funding from Astellas Pharma Global Development (Northbrook, IL). The other authors have no conflicts to disclose.
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The study was funded in part by Astellas Pharma Global Development (Northbrook, IL). The funding source had no input in the study design, execution, data analysis, data interpretation, or manuscript preparation and approval.
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Kattoor, A.J., Kolkailah, A.A., Iskander, F. et al. The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date. J. Nucl. Cardiol. 28, 2799–2807 (2021). https://doi.org/10.1007/s12350-020-02135-y
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DOI: https://doi.org/10.1007/s12350-020-02135-y