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The prognostic implications of ST-segment and T-wave abnormalities in patients undergoing regadenoson stress SPECT myocardial perfusion imaging

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The prognostic implications of ST-segment and T-wave (ST/T) abnormalities in patients undergoing stress SPECT-myocardial perfusion imaging (MPI) are not well defined.

Methods and Results

This was a single-center, retrospective cohort study of consecutive patients who underwent regadenoson stress SPECT-MPI. Patients with baseline electrocardiogram (ECG) abnormalities that impede ST/T analysis or those with known coronary artery disease were excluded. Patients were categorized as having primary ST abnormalities, secondary ST/T abnormalities due to ventricular hypertrophy or right bundle branch block, T-wave abnormalities, or normal ECG. The primary outcome was major adverse cardiovascular events (MACE) defined as the composite of cardiac death or myocardial infarction. Among 6,059 subjects, 1912 (32%) had baseline ST/T abnormalities. During a mean follow-up of 2.3 ± 1.9 years, the incidence of MACE was significantly higher among patients with secondary ST/T abnormalities compared to those with normal ECG (HR 2.05; 95% confidence interval [CI], 1.04-4.05; P = 0.039). No significant difference in MACE was observed among patients with primary ST abnormalities (HR 1.64; CI 0.87-3.06; P = 0.124) or T-wave abnormalities (HR 1.15; CI 0.62-2.16; P = 0.658) compared with patients who had normal ECG. Among patients with secondary ST/T changes, abnormal MPI was not associated with a significant increase in MACE rates compared to normal MPI (HR 1.18; CI 0.31-4.58; P = 0.808). However, abnormal MPI was associated with higher MACE rates among patients with primary ST abnormalities (HR 4.50; CI 1.44-14.10; P = 0.005) and T-wave abnormalities (HR 3.74; CI 1.20-11.68; P = 0.015). Similarly, myocardial ischemia on regadenoson stress SPECT-MPI was not associated with a significant increase in MACE rates in patients with secondary ST/T abnormalities (HR 1.45; CI 0.38-5.61; P = 0.588), while it was associated with a higher incidence of MACE in patients with primary ST abnormalities (HR 3.012; CI 0.95-9.53; P = 0.049) and T-wave abnormalities (HR 5.06; CI 1.60-15.96; P = 0.002).

Conclusion

While patients with secondary ST/T abnormalities had significantly higher MACE risk, abnormal MPI or presence of myocardial ischemia on regadenoson SPECT-MPI in this group does not add prognostic information. Patients with primary ST abnormalities and T-wave abnormalities do not seem to have a significantly higher MACE risk compared to those with normal ECG; however, abnormal MPI or presence of myocardial ischemia, in these groups, correlates with higher MACE rates.

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Abbreviations

CAD:

Coronary Artery Disease

ST/T:

ST-segment and T-wave

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiovascular events

MPI:

Myocardial Perfusion Imaging

MI:

Myocardial Infarction

SDS:

Summed difference scores

SRS:

Summed rest scores

SSS:

Summed stress scores

TID:

Transient ischemic dilation

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Authors and Affiliations

  1. Department of Medicine, Cook County Health, Chicago, IL, USA

    Muhammad Shahzeb Khan MD, MSc, Abdul Wahab Arif MD & Rami Doukky MD, MSc, FASNC

  2. Division of Cardiology, Cook County Health, 1901 W. Harrison St., Chicago, IL, 60612, USA

    Rami Doukky MD, MSc, FASNC

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

    Rami Doukky MD, MSc, FASNC

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Correspondence to Rami Doukky MD, MSc, FASNC.

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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 and interpretation, or manuscript preparation and approval. The authors have no conflicts to disclose.

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Baseline ST/T abnormalities have significant prognostic implications. #Regadenoson #MPI provides additional risk stratification. @RamiDoukky @ShahzebKhanMD @CookCtyHealth @RushMedical #CVNuc @JNCjournal @MyASNC.

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Khan, M.S., Arif, A.W. & Doukky, R. The prognostic implications of ST-segment and T-wave abnormalities in patients undergoing regadenoson stress SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 29, 810–821 (2022). https://doi.org/10.1007/s12350-020-02382-z

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