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The significance of post-stress decrease in left ventricular ejection fraction in patients undergoing regadenoson stress gated SPECT myocardial perfusion imaging

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Journal of Nuclear Cardiology Aims and scope

ABSTRACT

Background

The significance of post-stress decrease in left ventricular ejection fraction (LVEF) with regadenoson stress gated SPECT (GSPECT) myocardial perfusion imaging (MPI) has not been studied.

Methods and Results

Consecutive patients who underwent rest/regadenoson stress GSPECT-MPI followed by coronary angiography within 6 months were analyzed. Change in LVEF by GSPECT-MPI was calculated as stress LVEF minus rest LVEF; a significant decrease was tested at 5% and 10% thresholds. In a diagnostic cohort of 793 subjects, LVEF change was not predictive of severe/extensive coronary artery disease (area under the curve, 0.50; 95% confidence interval, 0.44-0.57; P = 0.946). There was no significant difference in the rates of severe/extensive coronary artery disease in patients with or without a decrease in LVEF, irrespective of MPI findings. In an outcome cohort of the 929 subjects followed for 30 ± 16 months, post-regadenoson stress decrease in LVEF was not associated with increased risk of the composite endpoint of cardiac death or myocardial infarction or in the risk of coronary revascularization.

Conclusions

In patients selected to undergo coronary angiography following regadenoson stress GSPECT-MPI, a decrease in LVEF after regadenoson stress is not predictive of severe/extensive CAD or adverse clinical outcomes, irrespective of MPI findings.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

GSPECT:

Gated single-photon emission computed tomography

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

SDS:

Summed difference score

SSS:

Summed stress score

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Disclosure

Rami Doukky has served on an Advisory Board for Astellas Pharma and receives research funding from Astellas Pharma. The other authors have no conflicts to report.

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Authors and Affiliations

  1. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA

    Javier Gomez MD, Yasmeen Golzar MD, Adebayo Olusanya MD, MPH & Rami Doukky MD, MSc

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

    Ibtihaj Fughhi MD, MSc & Rami Doukky MD, MSc

  3. Division of Cardiology, Rutgers, New Jersey Medical School, Newark, NJ, USA

    Adebayo Olusanya MD, MPH

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  1. Javier Gomez MD
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  2. Yasmeen Golzar MD
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  3. Ibtihaj Fughhi MD, MSc
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  4. Adebayo Olusanya MD, MPH
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  5. Rami Doukky MD, MSc
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Correspondence to Rami Doukky MD, MSc.

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Gomez, J., Golzar, Y., Fughhi, I. et al. The significance of post-stress decrease in left ventricular ejection fraction in patients undergoing regadenoson stress gated SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 25, 1313–1323 (2018). https://doi.org/10.1007/s12350-017-0802-6

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