Skip to main content
SpringerLink
Log in

Prognostic utility of splenic response ratio in dipyridamole PET myocardial perfusion imaging

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Cardiac magnetic resonance perfusion studies with adenosine stress have shown that splenic response can identify patients with inadequate pharmacologic stress. We investigate the incremental prognostic impact of splenic response ratio (SRR) in patients with normal Rubidium (Rb)-82 PET myocardial perfusion imaging (MPI).

Methods

Consecutive patients undergoing dipyridamole Rb-82 PET MPI for the evaluation of coronary artery disease were screened. Spleen and liver Rb-82 activity was measured and the SRR was calculated: SRR = (Spleen stress/Liver stress)/(Spleen rest/Liver rest). Major adverse cardiac events (MACE) were determined at 1 year of follow-up in patients with normal summed stress score and normal summed difference score.

Results

Of the 839 patients screened, the spleen was visualized in 703 (84%) of scans. There was significantly higher MACE observed in splenic non-responders vs splenic responders in both the normal SSS (7.8% vs 2.9%, P = .027) and the normal SDS groups (7.4% vs 2.2%, P = .014). In multivariate analysis in patients with normal SDS, splenic response was a significant, independent predictor of MACE (HR 2.97, 95% CI 1.10 to 8.04, P = .033).

Conclusions

SRR is a novel imaging metric to identify patients with sub-maximal vasodilator stress and an incremental prognostic marker in patients with normal SDS and SSS (Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT01128023).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Abbreviations

HD:

Hemodynamic

CT:

Computed tomography

MACE:

Major adverse cardiac events

MFR:

Myocardial blood flow reserve

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

Rb:

Rubidium

SDS:

Summed difference score

SRR:

Splenic response ratio

SSS:

Summed stress score

References

  1. Mc Ardle BA, Dowsley TF, deKemp RA, Wells GA, Beanlands RS. Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease? A systematic review and meta-analysis. J Am Coll Cardiol. 2012;60:1828-37.

    Article  Google Scholar 

  2. Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography in the detection of coronary artery disease. J Am Coll Cardiol. 2007;49:1052-8.

    Article  CAS  Google Scholar 

  3. Kidambi A, Sourbron S, Maredia N, Motwani M, Brown JM, Nixon J, et al. Factors associated with false-negative cardiovascular magnetic resonance perfusion studies: A clinical evaluation of magnetic resonance imaging in coronary artery disease (CE-MARC) substudy. J Magn Reson Imaging. 2016;43:566-73.

    Article  Google Scholar 

  4. Sandler MP, Kronenberg MW, Forman MB, Wolfe OH, Clanton JA, Partain CL. Dynamic fluctuations in blood and spleen radioactivity: Splenic contraction and relation to clinical radionuclide volume calculations. J Am Coll Cardiol. 1984;3:1205-11.

    Article  CAS  Google Scholar 

  5. Hunter CR, Hill J, Ziadi MC, Beanlands RS, deKemp RA. Biodistribution and radiation dosimetry of (82)Rb at rest and during peak pharmacological stress in patients referred for myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2015;42:1032-42.

    Article  CAS  Google Scholar 

  6. Bryant JAA, Harden S, George S, Shambrook J, Peebles C. Early clinical experience with “splenic switch-off” in adenosine stress CMR. J Cardiovasc Magn Reson. 2015;17:91.

    Article  Google Scholar 

  7. Manisty C, Ripley DP, Herrey AS, Captur G, Wong TC, Petersen SE, et al. Splenic switch-off: A tool to assess stress adequacy in adenosine perfusion cardiac MR imaging. Radiology. 2015;276:732-40.

    Article  Google Scholar 

  8. Ziadi MC, Dekemp RA, Williams KA, Guo A, Chow BJ, Renaud JM, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol. 2011;58:740-8.

    Article  Google Scholar 

  9. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: Differential stratification for risk of cardiac death and myocardial infarction.[Erratum appears in Circulation 1998 Jul 14;98(2):190]. Circulation. 1998;97:535-43.

    Article  CAS  Google Scholar 

  10. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol. 2004;43:200-8.

    Article  Google Scholar 

  11. Guntheroth WG, Mullins GL. Liver and spleen as venous reservoirs. Am J Physiol. 1963;204:35-41.

    Article  CAS  Google Scholar 

  12. Mustafa SJ, Morrison RR, Teng B, Pelleg A. Adenosine receptors and the heart: Role in regulation of coronary blood flow and cardiac electrophysiology. Handb. 2009;193:161-88.

    CAS  Google Scholar 

  13. Fozard JR, Milavec-Krizman M. Contraction of the rat isolated spleen mediated by adenosine A1 receptor activation. Br J Pharmacol. 1993;109:1059-63.

    Article  CAS  Google Scholar 

  14. Torres FS, Foppa M. Splenic switch-off for stress cardiovascular MR imaging and dipyridamole. Radiology. 2015;277:613-4.

    Article  Google Scholar 

  15. Wang T, Mentzer RM Jr, Van Wylen DG. Interstitial adenosine with dipyridamole: Effect of adenosine receptor blockade and adenosine deaminase. Am J Physiol. 1992;263(2 Pt 2):H552-8.

    CAS  PubMed  Google Scholar 

  16. Senthamizhchelvan S, Bravo PE, Esaias C, Lodge MA, Merrill J, Hobbs RF, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med. 2010;51(10):1592-9.

    Article  Google Scholar 

  17. Conti A, Mariannini Y, Canuti E, Petrova T, Innocenti F, Zanobetti M, et al. Nuclear scan strategy and outcomes in chest pain patients value of stress testing with dipyridamole or adenosine. World J. 2014;13(2):94-101.

    Google Scholar 

Download references

Disclosures

Karan Bami, Shrankhala Tewari, Fadi Guirguis, Linda Garrard, and Ann Guo have nothing to disclose. Terrence D. Ruddy has research grants from GE HealthCare and Advanced Accelerator Applications. Robert A. deKemp reports grants, consulting fees, and license revenues from Jubilant DraxImage and University of Ottawa Heart Institute (UOHI), outside the submitted work. Rob S. B. Beanlands reports grants and honoraria from Lantheus Medical Imaging, grants and honoraria from Jubilant DraxImage, and grants from GE Healthcare, outside the submitted work. Rob S. B. Beanlands is a Career Investigator supported but the Heart and Stroke Foundation of Ontario and a Tier 1 Research Chair supported by the University of Ottawa. Benjamin J. W. Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research. He receives research support from CV Diagnostix and educational support from TeraRecon Inc. Girish Dwivedi was supported by a CIHR new investigator salary support award while at UOHI. Currently he is Wesfarmers Chair in Cardiology at University of Western Australia with an Adjunct Professor appointment at UOHI. The study was performed at UOHI.

Author information

Author notes

  1. Benjamin J. W. Chow and Girish Dwivedi are Joint senior authors.

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, National Cardiac PET Centre, University of Ottawa Heart Institute (UOHI), University of Ottawa, Ottawa, ON, Canada

    Karan Bami MD, Shrankhala Tewari BSc, Fadi Guirguis BSc, Linda Garrard RN, BScN, Ann Guo MSc, Alomgir Hossain PhD, Terrence D. Ruddy MD FRCPC, Rob S. B. Beanlands MD FRCPC, Robert A. deKemp PhD, Benjamin J. W. Chow MD FRCPC & Girish Dwivedi MD PhD

  2. Harry Perkins Institute of Medical Research and Fiona Stanley Hospital (Murdoch), University of Western Australia, 6 Verdun Street, Nedlands, WA, 6009, Australia

    Girish Dwivedi MD PhD

Authors
  1. Karan Bami MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shrankhala Tewari BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fadi Guirguis BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Garrard RN, BScN
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ann Guo MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alomgir Hossain PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Terrence D. Ruddy MD FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rob S. B. Beanlands MD FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robert A. deKemp PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Benjamin J. W. Chow MD FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Girish Dwivedi MD PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Girish Dwivedi MD PhD.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1539 kb)

Supplementary material 2 (DOC 55 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bami, K., Tewari, S., Guirguis, F. et al. Prognostic utility of splenic response ratio in dipyridamole PET myocardial perfusion imaging. J. Nucl. Cardiol. 26, 1888–1897 (2019). https://doi.org/10.1007/s12350-018-1269-9

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-018-1269-9

Keywords

Search

Navigation