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Diagnostic and 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

The diagnostic and prognostic value of regadenoson-induced ST-segment depression (ST↓) is not defined. Due to the low incidence of ST↓ ≥1.0 mm with vasodilator stress, a lower threshold to define ischemic ECG response may provide improved clinical utility.

Methods

We conducted a retrospective cohort study of patients who underwent regadenoson-stress SPECT myocardial perfusion imaging (MPI) followed by coronary angiography within 6 months. Ischemic ST↓ was defined as ≥0.5 mm. The prevalence of angiographically severe coronary artery disease (CAD) and the rates of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and coronary revascularization were determined.

Results

In a diagnostic cohort of 629 subjects, 117 (18.6%) had ST↓ ≥0.5 mm. Severe CAD was more prevalent in the ST↓ ≥0.5 vs ST <0.5 group (13.7% vs 5.3%, P = .001). Among patients with normal MPI (n = 229), the prevalence of severe CAD was higher in the ST↓ ≥0.5 group (8.2% vs 2.2%, P = .04). Adjusting for clinical and imaging covariates, ST↓ ≥0.5 mm was independently predictive of severe CAD [odds ratio = 3.37, 95% confidence interval (CI) = 1.67-6.83, P = .001], and provided incremental diagnostic value (Chi square increment = 10.3, P = .001). In an outcome cohort of 748 subjects, after adjusting for clinical and imaging covariates, ST↓ ≥0.5 mm was associated with increased MACE rate in the entire cohort [hazard ratio = 1.41, CI 1.01-1.96, P = .04] and in the subgroup of patients with normal MPI [hazard ratio = 2.2, CI 1.11-4.39, P = .02], and provided incremental prognostic value (Chi square increment = 3.9, P = .049). A diagnostic ST↓ threshold of 0.5 mm provided greater discriminatory capacity than a 1.0 mm cutoff (P = .03).

Conclusions

Among patients selected to undergo coronary angiography, regadenoson-induced ST↓ ≥0.5 mm was associated with higher rates of severe CAD and MACE, irrespective of MPI finding.

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Disclosure

Rami Doukky has served on the Advisory Board of Astellas Pharma, USA, and received investigator initiated research grant support from Astellas Pharma, USA. No conflict of interests to be reported by other authors.

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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

    Rami Doukky MD, MSc, FACC, FASNC, Adebayo Olusanya MD, Raj Vashistha MD, Abhimanyu Saini MD & Khaled Mansour MD

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

    Rami Doukky MD, MSc, FACC, FASNC & Ibtihaj Fughhi MD

  3. Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA

    Abiy Nigatu MD

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

    Kara Confer BS & Shannon A. Sims MD, PHD

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  1. Rami Doukky MD, MSc, FACC, FASNC
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  2. Adebayo Olusanya MD
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Correspondence to Rami Doukky MD, MSc, FACC, FASNC.

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Doukky, R., Olusanya, A., Vashistha, R. et al. Diagnostic and prognostic significance of ischemic electrocardiographic changes with regadenoson-stress myocardial perfusion imaging. J. Nucl. Cardiol. 22, 700–713 (2015). https://doi.org/10.1007/s12350-014-0047-6

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  • DOI: https://doi.org/10.1007/s12350-014-0047-6

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