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Prognostic significance of post-stress reduction in left ventricular ejection fraction with adenosine stress in Jordanian patients with normal myocardial perfusion

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The significance of post-stress reduction in left ventricular ejection fraction (LVEF) in patients with normal perfusion on adenosine stress/rest imaging remains controversial.

Methods

Consecutive patients who underwent 2-day adenosine gated stress/rest 99mTc-sestamibi imaging and had normal perfusion were analyzed. LVEF was quantified at rest and 1 hour post-adenosine. Patients were followed up for hard (cardiac death or nonfatal MI) and soft (coronary revascularization or congestive heart failure) cardiac events for 24.1 ± 11.0 months.

Results

Of 560 patients included in the study, 135 (24.1%) had a post-stress reduction in LVEF of ≥ 5%. Rest LVEF (P < 0.001), known history of CAD (P = 0.01) and transient ischemic dilatation ratio (P = 0.02) were independent predictors of LVEF reduction. Event-free survivals were similar in patients with and without ≥ 5% LVEF reduction (P = 0.8). The unadjusted hazard ratio (95% CI) for cardiac events for ≥ 5% LVEF reduction was 1.09 (0.55-2.15), P = 0.81, while the hazard ratio adjusted for known history of CAD, smoking, post-stress LVEF and peak heart rate was 0.87 (0.44-1.75), P = 0.71.

Conclusions

Significant post-adenosine reduction in LVEF occurs in about one-fourth of patients with normal perfusion but does not confer adverse prognosis compared with patients without such reduction.

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Abbreviations

EF:

Ejection fraction

LV:

Left ventricular

MBq:

Megabecquerel

mCi:

Millicurie

SPECT:

Single photon emission computerized tomography

SSS:

Summed stress score

SRS:

Summed rest score

SDS:

Summed difference score

Tc-99m:

Technetium-99m

MI:

Myocardial infarction

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Disclosure

The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. Division of Cardiology/Department of Medicine, University of Jordan, Amman, Jordan

    Omar S. Obeidat MD, Abdullah Alhouri MD, Bayan Baniissa MD, Omar Alqaisi MD, Mohammad Akkawi MD, Heba Zyad MD, Omar Alrimawi MD, Hamza Jawabreh MD, Odai Al-Batsh MD & Othman Alaraj MD

  2. Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Queen Rania Street, Al Jubeiha, Amman, 11942, Jordan

    Mira Al Jabi MD, Saba Jaradat MD & Malik E. Juweid MD

Authors
  1. Omar S. Obeidat MD
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  2. Abdullah Alhouri MD
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  3. Bayan Baniissa MD
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Contributions

OSO, MEJ: contributed to the conception and design of the study, analysis and interpretation of data, drafting and final approval of the manuscript. AA, BB, OA, MA, HZ, OA, MAJ, SJ, HJ, OA, OA: actively involved in collecting and analyzing data and approved the of final manuscript.

Corresponding author

Correspondence to Malik E. Juweid MD.

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Obeidat, O.S., Alhouri, A., Baniissa, B. et al. Prognostic significance of post-stress reduction in left ventricular ejection fraction with adenosine stress in Jordanian patients with normal myocardial perfusion. J. Nucl. Cardiol. 27, 1596–1606 (2020). https://doi.org/10.1007/s12350-019-01725-9

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