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Prognostic significance of ischemic electrocardiographic changes with regadenoson stress myocardial perfusion imaging

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In patients undergoing regadenoson SPECT myocardial perfusion imaging (MPI), the prognostic value of ischemic ST-segment depression (ST↓) and the optimal ST↓ threshold have not been studied.

Methods

A retrospective cohort study of consecutive patients referred for regadenoson stress MPI was conducted. Patients with uninterpretable ECG were excluded. Two diagnostic thresholds of horizontal or downsloping ST↓ were studied, ≥ 0.5 mm and ≥ 1.0 mm. The primary endpoint was the composite major adverse cardiac events (MACE) of cardiac death, myocardial infarction, or coronary revascularization.

Results

Among 8615 subjects (mean age 62 ± 13 years; 55% women), 89 (1.0%) had ST↓ ≥ 1.0 mm and 133 (1.5%) had ST↓ ≥ 0.5 mm. Regadenoson-induced ST↓ was more common in women (P < .001). Mean follow-up was 2.5 ± 2.2 years. After multivariate adjustment, ST↓ ≥ 1.0 mm was associated with a non-significant increase in MACE risk (P = .069), irrespective to whether MPI was abnormal (P = .162) or normal (P = .214). Ischemic ST↓ ≥ 0.5 mm was independently associated with MACE in the entire cohort (HR 2.14; CI 1.38-3.32; P = .001), whether MPI is normal (HR 2.07; CI 1.07-4.04; P = .032) or abnormal (HR 2.24; CI 1.23-4.00; P = .007), after adjusting for clinical and imaging covariates. An ST↓ threshold of ≥ 0.5 mm provided greater incremental prognostic value beyond clinical and imaging parameters (Δχ2 = 12.78; P < .001) than ≥ 1.0 mm threshold (Δχ2 = 3.72; P = .093).

Conclusion

Regadenoson-induced ischemic ST↓ is more common in women and it provides a modest independent prognostic value beyond MPI and clinical parameters. ST↓ ≥ 0.5 mm is a better threshold than ≥ 1.0 mm to define ECG evidence for regadenoson-induced myocardial ischemia.

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Abbreviations

AUC:

Area under the curve

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

ECG:

Electrocardiogram

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

ST↓:

ST-segment depression

TID:

Transient ischemic dilation

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Disclosures

Rami Doukky receives research funding from Astellas Pharma Global Development (Northbrook, IL). The other authors have no conflicts to disclose.

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Authors and Affiliations

  1. Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA

    Rami Doukky MD, MSc, FASNC, Abiy Nigatu MD, Ali Ayoub MD, Fady Iskander MD, MSc, Mina Iskander MD, MSc & Javier Gomez MD, MSc

  2. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, FASNC, Rozi Khan MD, Chiedozie Anokwute MD, Ibtihaj Fughhi MD, MSc, Snigdha Kola MD & Mark Sahyouni

  3. Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, FASNC & Kelly Karavolos MA

  4. Department of Medicine, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, FASNC & Bala N. Hota MD

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  1. Rami Doukky MD, MSc, FASNC
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  2. Abiy Nigatu MD
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Correspondence to Rami Doukky MD, MSc, FASNC.

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The study was funded by a research grant from Astellas Pharma Global Development (Northbrook, IL).

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Doukky, R., Nigatu, A., Khan, R. et al. Prognostic significance of ischemic electrocardiographic changes with regadenoson stress myocardial perfusion imaging. J. Nucl. Cardiol. 27, 1521–1532 (2020). https://doi.org/10.1007/s12350-018-1415-4

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