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The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Data on the prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) is limited and based on small cohorts.

Methods and Results

We conducted a single-center, retrospective cohort study of 10,275 consecutive patients who underwent regadenoson SPECT-MPI. Among the study subjects, 28.7% had abnormal MPI and 25.5% had myocardial ischemia. Patients were followed for a mean of 2.4 ± 2.2 years for major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. There was a significant stepwise increase in MACE with an increasing burden of perfusion abnormality (P < .001) and myocardial ischemia (P < .001). Abnormal MPI (adjusted HR 1.52; 95% CI 1.21 to 1.91) and myocardial ischemia (adjusted HR 1.53; 95% CI 1.25 to 1.89) were associated with MACE, independent of and incremental to clinical covariates and left ventricular ejection fraction (LVEF). Moreover, post-stress LVEF, LVEF reserve, and left ventricular end-diastolic volume added significant prognostic information. Transient ischemic dilation ≥ 1.31 did not provide incremental prognostic value (adjusted HR 1.02; P = .906).

Conclusion

In the largest cohort to date, we demonstrated that the presence and severity of perfusion abnormality and myocardial ischemia on regadenoson stress SPECT-MPI are associated with an independent increase in MACE.

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Abbreviations

CAD:

Coronary artery disease

CD:

Cardiac death

CR:

Coronary revascularization

ESRD:

End-stage renal disease

IDI:

Integrated discrimination improvement

LCR:

Late coronary revascularization

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

SDS:

Summed difference score

SSS:

Summed stress score

TID:

Transient ischemic dilation

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Disclosure

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

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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, data interpretation, or manuscript preparation and approval.

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Kattoor, A.J., Kolkailah, A.A., Iskander, F. et al. The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date. J. Nucl. Cardiol. 28, 2799–2807 (2021). https://doi.org/10.1007/s12350-020-02135-y

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