Abstract
Aims
In most Rubidium-(Rb)-positron emission tomography (PET) studies, dipyridamole was used as vasodilator. The aim was to evaluate vasodilator PET left ventricular ejection fraction (LVEF), myocardial blood flow (MBF), hemodynamics, and the influence of adenosine and regadenoson on these variables.
Methods and results
Consecutive patients (N = 2299) with prior coronary artery disease (CAD) or no prior CAD undergoing adenosine/regadenoson 82Rb-PET were studied and compared according to CAD status and normal/abnormal PET (summed stress score 0-3 vs. ≥4). Rest and stress LVEF differed significantly depending on CAD status and scan results. In patients with no prior CAD, rest/stress LVEF were 68% and 72%, in patients with prior CAD 60% and 63%. LVEF during stress increased 5 ± 6% in normal compared to 1 ± 8% in abnormal PET (P<0.001). Global rest myocardial blood flow(rMBF), stress MBF(sMBF) and myocardial flow reserve (sMBF/rMBF) were significantly higher in no prior CAD patients compared to prior CAD patients(1.3 ± 0.5, 3.3 ± 0.9, 2.6 ± 0.8 and 1.2 ± 0.4, 2.6 ± 0.8, 2.4 ± 0.8 ml/g/min, respectively, P<0.001) and in normal versus abnormal scans, irrespective of CAD status(no prior CAD: 1.4 ± 0.5, 3.5 ± 0.8, 2.8 ± 0.8 and 1.2 ± 0.8, 2.5 ± 0.8, 2.2 ± 0.7; prior CAD: 1.3 ± 0.4, 3.1 ± 0.8, 2.7 ± 0.8 and 1.1 ± 0.4, 2.3 ± 0.7, 2.2 ± 0.7 ml/g/min, respectively, P<0.001). LVEF and hemodynamic values were similar for adenosine and regadenoson stress. Stress LVEF ≥70% excluded relevant ischemia (≥10%) with a negative predictive value (NPV) of 94% (CI 92-95%).
Conclusions
Rest/stress LVEF, LVEF reserve and MBF values are lower in abnormal compared to normal scans. Adenosine and regadenoson seem to have similar effect on stress LVEF, MBF and hemodynamics. A stress LVEF ≥70% has a high NPV to exclude relevant ischemia.
Chinese Abstract
背景
在大多数铷-正电子断层扫描 (Rb-PET)中,双嘧达莫是常见的血管扩张剂。本研究目的是评估血管扩张剂腺苷和瑞加德松PET扫描时对左心室射血分数 (LVEF)、心肌血流量 (MBF)、血流动力学这些变量的影响。
方法与结果
对接受腺苷/瑞加德松进行 82Rb-PET 的 2299 名连续就诊的疑似或已知冠状动脉疾病 (CAD)患者进行研究,并根据 CAD 状态和PET正常/异常(总负荷积分 0-3 与 ≥ 4)进行分组比较。 对CAD患者的状态和扫描结果分析可以发现静息和负荷状态下的LVEF显著不同。在疑似CAD患者中,静息/负荷状态下的LVEF分别为 68% 和73%,在既往CAD患者中静息/负荷状态下的LVEF分别为 60%和63%。PET正常组负荷LVEF增加5±6%,PET异常组LVEF增加 1±8% (p < 0.001)。疑似CAD组的整体静息心肌血流量(rest myocardial blood flow, rMBF)、负荷MBF(stress myocardial blood flow, sMBF)和心肌血流储备(sMBF/rMBF)显著高于既往CAD组(分别为 1.3±0.5、3.3±0.9、2.6±0.8和1.2±0.4、2.6±0.8、2.4±0.8 ml/g/min,p<0.001);与PET异常组比较,PET正常组的rMBF、sMBF和MFR明显增高,并且与CAD状态无关(无 CAD: 1.4±0.5、3.5±0.8、2.5±0.8和1.2±0.8, 2.5±0.8, 2.2±0.7 ml/g/min;确诊 CAD: 1.3±0.4,3.1±0.8,2.7±0.8和1.1±0.4,2.3±0.7,2.2 ±0.7ml/g/min, p<0.001)。腺苷和瑞加德松负荷的LVEF和血液动力学参数相似。负荷LVEF ≥70%排除相对缺血(面积≥10%)的阴性预测值(NPV)为94%(置信区间92-95%)。
结论
与正常的PET扫描相比,LVEF、LVEF储备和MBF值在PET异常情况下降低。腺苷和瑞加德松对负荷 LVEF、MBF和血流动力学有相似的作用。负荷 LVEF ≥70% 对排除相对缺血具有高 NPV 。
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Abbreviations
- MPI:
-
Myocardial perfusion imaging
- PET:
-
Positron emission tomography
- SPECT:
-
Single photon emission computed tomography
- CT:
-
Computed tomography
- Rb:
-
Rubidium
- CAD:
-
Coronary artery disease
- COPD:
-
Chronic obstructive pulmonary disease
- MBF:
-
Myocardial blood flow
- MFR:
-
Myocardial flow reserve
- CABG:
-
Coronary artery bypass graft
- PCI:
-
Percutaneous coronary intervention
- LVEF:
-
Left ventricular ejection fraction
- BP:
-
Blood pressure
- HR:
-
Heart rate
- ECG:
-
Electrocardiogram
- SRS:
-
Summed rest score
- SSS:
-
Summed stress score
- SDS:
-
Summed difference score
- BMI:
-
Body mass index
- LV:
-
Left ventricle
- ESV:
-
End systolic volume
- EDV:
-
End diastolic volume
- SD:
-
Standard deviation
- IQR:
-
Interquartile range
References
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-77.
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60(24):e44-164.
Dorbala S, Vangala D, Sampson U, Limaye A, Kwong R, Di Carli MF. Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: A 82Rb PET/CT study. J Nucl Med. 2007;48(3):349-58.
Brown TLY, Merrill J, Volokh L, Bengel FM. Determinants of the response of left ventricular ejection fraction to vasodilator stress in electrocardiographically gated 82rubidium myocardial perfusion PET. Eur J Nucl Med Mol Imaging. 2008;35(2):336-42.
Hsiao E, Ali B, Blankstein R, Skali H, Ali T, Bruyere J Jr, et al. Detection of obstructive coronary artery disease using regadenoson stress and 82Rb PET/CT myocardial perfusion imaging. J Nucl Med. 2013;54(10):1748-54.
Dorbala S, Hachamovitch R, Curillova Z, Thomas D, Vangala D, Kwong RY, et al. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging. 2009;2(7):846-54.
Lertsburapa K, Ahlberg AW, Bateman TM, Katten D, Volker L, Cullom SJ, et al. Independent and incremental prognostic value of left ventricular ejection fraction determined by stress gated rubidium 82 PET imaging in patients with known or suspected coronary artery disease. J Nucl Cardiol. 2008;15(6):745-53.
Shryock JC, Belardinelli L. Adenosine and adenosine receptors in the cardiovascular system: Biochemistry, physiology, and pharmacology. Am J Cardiol. 1997;79(12 A):2-10.
Zoghbi GJ, Iskandrian AE. Selective adenosine agonists and myocardial perfusion imaging. J Nucl Cardiol. 2012;19(1):126-41.
Al Jaroudi W, Iskandrian AE. Regadenoson: a new myocardial stress agent. J Am Coll Cardiol. 2009;54(13):1123-30.
Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging. Integrated. Advance-MPI Trial Results. JACC Cardiovasc Imaging 2008;1(3):307-16
Slomka PJ, Alexanderson E, Jácome R, Jiménez M, Romero E, Meave A, et al. Comparison of clinical tools for measurements of regional stress and rest myocardial blood flow assessed with 13N-ammonia PET/CT. J Nucl Med. 2012;53(2):171-81.
Van Tosh A, Votaw JR, Reichek N, Palestro CJ, Nichols KJ. The relationship between ischemia-induced left ventricular dysfunction, coronary flow reserve, and coronary steal on regadenoson stress-gated 82Rb PET myocardial perfusion imaging. J Nucl Cardiol. 2013;20(6):1060-8.
Hung G, Lee K, Chen C, Yang K, Lin W. Worsening of left ventricular ejection fraction induced by dipyridamole on Tl-201 gated myocardial perfusion imaging predicts significant coronary artery disease. J Nucl Cardiol. 2006;13(2):225-32.
Manrique A, Hitzel A, Brasse D, Véra P. Effect of perfusion pattern and imaging sequence on gated perfusion SPECT evaluation of myocardial stunning. J Nucl Med. 2005;46(1):176-83.
Tanaka H, Chikamori T, Hida S, Usui Y, Harafuji K, Igarashi Y, et al. Comparison of post-exercise and post-vasodilator stress myocardial stunning as assessed by electrocardiogram-gated single-photon emission computed tomography. Circ J. 2005;69(11):1338-45.
Bravo PE, Chien D, Javadi M, Merrill J, Bengel FM. Reference ranges for LVEF and LV volumes from electrocardiographically gated 82Rb cardiac PET/CT using commercially available software. J Nucl Med. 2010;51(6):898-905.
Menezes LJ, Groves AM, Prvulovich E, Dickson JC, Endozo R, Shastry MH, et al. Assessment of left ventricular function at rest using rubidium-82 myocardial perfusion PET: Comparison of four software algorithms with simultaneous 64-slice coronary CT angiography. Nucl Med Commun. 2009;30(12):918-25.
Nakazato R, Berman DS, Dey D, Le Meunier L, Hayes SW, Fermin JS, et al. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: Normal limits and correlation with invasive coronary angiography. J Nucl Cardiol. 2012;19(2):265-76.
Prior JO, Allenbach G, Valenta I, Kosinski M, Burger C, Verdun FR, et al. Quantification of myocardial blood flow with 82Rb positron emission tomography: Clinical validation with 15O-water. Eur J Nucl Med Mol Imaging. 2012;39(6):1037-47.
El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with 82Rb PET: Comparison with 13N-ammonia PET. J Nucl Med. 2009;50(7):1062-71.
Sunderland JJ, Pan X-B, Declerck J, Menda Y. Dependency of cardiac rubidium-82 imaging quantitative measures on age, gender, vascular territory, and software in a cardiovascular normal population. J Nucl Cardiol. 2015;22(1):72-84.
Oliveira JB, Sen YM, Wechalekar K. Intersoftware variability impacts classification of cardiac PET exams. J Nucl Cardiol. 2019;26(6):2007-12.
Goudarzi B, Fukushima K, Bravo P, Merrill J, Bengel FM. Comparison of the myocardial blood flow response to Regadenoson and dipyridamole: A quantitative analysis in patients referred for clinical 82Rb myocardial perfusion PET. Eur J Nucl Med Mol Imaging. 2011;38(10):1908-16.
Cullom SJ, Case JA, Courter SA, McGhie AI, Bateman TM. Regadenoson pharmacologic rubidium-82 PET: A comparison of quantitative perfusion and function to dipyridamole. J Nucl Cardiol. 2013;20(1):76-83.
Christopoulos G, Bois JP, Kemp BJ, Askew JW, Rodriguez-Porcel M, Anavekar N, et al. Comparison of maximal hyperemic myocardial blood flow response between regadenoson and adenosine: A quantitative positron emission tomography 13N-ammonia study. Nucl Med Biomed Imaging. 2019;4:1-6.
Johnson NP, Gould KL. Regadenoson versus dipyridamole hyperemia for cardiac PET imaging. J Am Coll Cardiol Imaging. 2015;8(4):438-47.
Ababneh AA, Sciacca RR, Kim B, Bergmann SR. Normal limits for left ventricular ejection fraction and volumes estimated with gated myocardial perfusion imaging in patients with normal exercise test results: Influence of tracer, gender, and acquisition camera. J Nucl Cardiol. 2000;7(6):661-8.
Rozanski A, Nichols K, Yao SS, Malholtra S, Cohen R, DePuey EG. Development and application of normal limits for left ventricular ejection fraction and volume measurements from 99mTc-sestamibi myocardial perfusion gated SPECT. J Nucl Med. 2000;41(9):1445-50.
Katsikis A, Kyrozi E, Manira V, Theodorakos A, Malamitsi J, Tsapaki V, et al. Gender-related differences in side-effects and hemodynamic response to regadenoson in patients undergoing SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2019;46(12):2590-600.
Gebhard C, Stähli BE, Gebhard CE, Fiechter M, Fuchs TA, Stehli J, et al. Gender- and age-related differences in rest and post-stress left ventricular cardiac function determined by gated SPECT. Int J Cardiovasc Imaging. 2014;30(6):1191-9.
Naya M, Murthy VL, Taqueti VR, Foster CR, Klein J, Garber M, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med. 2014;55(2):248-55.
Nesterov SV, Deshayes E, Sciagrà R, Settimo L, Declerck JM, Pan X-B, et al. Quantification of myocardial blood flow in absolute terms using (82)Rb PET imaging: the RUBY-10 Study. JACC Cardiovasc Imaging. 2014;7(11):1119-27.
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SMF: data collection, statistical analysis, data interpretation, draft of manuscript, approval of final manuscript version. UH: data collection, statistical analysis, data interpretation, draft of manuscript, approval of final manuscript version. OFC: assistance with statistical analysis, critical revision, approval of final manuscript version. FC: critical revision, approval of final manuscript version. PH: critical revision, approval of final manuscript version. MJZ: senior author, concept and study design, data interpretation, critical revision, approval of final manuscript version
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Simon M. Frey, Ursina Honegger, Olivier F. Clerc, Federico Caobelli, Philip Haaf, and Michael J. Zellweger declares that they have no conflict of interest.
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Frey, S.M., Honegger, U., Clerc, O.F. et al. Left ventricular ejection fraction, myocardial blood flow and hemodynamic variables in adenosine and regadenoson vasodilator 82-Rubidium PET. J. Nucl. Cardiol. 29, 921–933 (2022). https://doi.org/10.1007/s12350-021-02729-0
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DOI: https://doi.org/10.1007/s12350-021-02729-0