Gender-related differences in side-effects and hemodynamic response to regadenoson in patients undergoing SPECT myocardial perfusion imaging
Athanasios KatsikisE. KyroziVasiliki ManiraAthanasios TheodorakosJ. MalamitsiVirginia TsapakiΙoannis IakovouVasilios VoudrisGenovefa KolovouMaria Koutelou
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AIM Left ventricular (LV) ejection fraction (EF) and perfusion defect size (PDS) provide independent and incremental prognostic information in patients with coronary artery disease (CAD). The purpose of this study was to examine the correlation between EF and PDS. METHODS LVEF and PDS were measured in 96 consecutive patients with CAD and abnormal perfusion scan using well-validated automated programs. The PDS was expressed as % of LV myocardium as total (reversible plus fixed), fixed or reversible. RESULTS The EF was 49±15% (range 17-84), the total PDS was 29±15% (2-77) and the fixed PDS was 20±13% (2-58). The end-diastolic volume (EDV) was 131±59 mL (29-342) and end-systolic volume (ESV) was 72±51 mL (4-283). There were moderate but significant correlations between EF and total PDS (r=-0.46, P<0.0001) and fixed PDS (r=-0.45, P<0.0001) but not with reversible PDS. In the subgroup analysis, the correlations were stronger in patients with history of prior coronary artery bypass grafting than without, and higher in men than women. The highest correlations were seen between EF and EDV in both men and women (r=-0.68 and -0.74 respectively, P<0.0001 each), and between EF and ESV (r =-0.80, P<0.0001). CONCLUSION Although there is a statistically significant correlation between PDS and EF, the correlation is not strong. This observation provides supportive evidence of why PDS and EF provide incremental prognostic information. It also supports the incremental prognostic merits of LV volume measurements.
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Purpose To compare the diagnostic performance of stress myocardial computed tomography (CT) perfusion with that of stress myocardial magnetic resonance (MR) perfusion imaging in the detection of coronary artery disease (CAD). Materials and Methods All patients gave written informed consent prior to inclusion in this institutional review board-approved study. This two-center substudy of the prospective Combined Noninvasive Coronary Angiography and Myocardial Perfusion Imaging Using 320-Detector Row Computed Tomography (CORE320) multicenter trial included 92 patients (mean age, 63.1 years ± 8.1 [standard deviation]; 73% male). All patients underwent perfusion CT and perfusion MR imaging with either adenosine or regadenoson stress. The predefined reference standards were combined quantitative coronary angiography (QCA) and single-photon emission CT (SPECT) or QCA alone. Results from coronary CT angiography were not included, and diagnostic performance was evaluated with the Mantel-Haenszel test stratified by disease status. Results The prevalence of CAD was 39% (36 of 92) according to QCA and SPECT and 64% (59 of 92) according to QCA alone. When compared with QCA and SPECT, per-patient diagnostic accuracy of perfusion CT and perfusion MR imaging was 63% (58 of 92) and 75% (69 of 92), respectively (P = .11); sensitivity was 92% (33 of 36) and 83% (30 of 36), respectively (P = .45); and specificity was 45% (25 of 56) and 70% (39 of 56), respectively (P < .01). When compared with QCA alone, diagnostic accuracy of CT perfusion and MR perfusion imaging was 82% (75 of 92) and 74% (68 of 92), respectively (P = .27); sensitivity was 90% (53 of 59) and 69% (41 of 59), respectively (P < .01); and specificity was 67% (22 of 33) and 82% (27 of 33), respectively (P = .27). Conclusion This multicenter study shows that the diagnostic performance of perfusion CT is similar to that of perfusion MR imaging in the detection of CAD. © RSNA, 2017 Online supplemental material is available for this article.
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Assessment of reversible defects in exercise (201)Tl perfusion SPECT has low sensitivity and high specificity for detection of multivessel coronary artery disease (CAD). The goal of this study was to evaluate whether the left ventricular ejection fraction (LVEF) in exercise (201)Tl gated SPECT had incremental diagnostic value over perfusion data for detection of multivessel CAD.One hundred eighty-two patients underwent exercise (201)Tl gated SPECT. Automated LV function analysis software was used for calculation of the postexercise and the rest LVEF. The best threshold between 0- to 1-vessel CAD and 2- to 3-vessel CAD was determined as the cutoff that on receiver-operating-characteristic analysis resulted in the best sensitivity for detection of multivessel CAD with an associated specificity of >90%.Only 18 (26.9%) of 67 patients with multivessel CAD had reversible defects in multiple territories. Sensitivities of the postexercise and the rest LVEF and the worsening of the LVEF by exercise did not differ from those of perfusion data alone. Sensitivities of the combination of perfusion data and the postexercise and rest LVEF did not differ from those of perfusion data alone, whereas the sensitivity of the combination of perfusion data and worsening of the LVEF (i.e., reversible defects in multiple territories or worsening of the LVEF >5.6% [or both]) was significantly greater than that of perfusion data alone (43.3% vs. 26.9%; P < 0.05), with an acceptable level of specificity (90.4%).The worsening of the LVEF by exercise has the potential to detect patients with multivessel CAD among those without multivessel patterns of reversible defects.
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Our objective was to study the diagnostic performance of regadenoson 82Rb myocardial perfusion PET imaging to detect obstructive coronary artery disease (CAD). Methods: We studied 134 patients (mean age, 63 ± 12 y; mean body mass index, 31 ± 9 kg/m2) without known CAD (96 with coronary angiography and 38 with low pretest likelihood of CAD). Stress left ventricular ejection fraction (LVEF) minus rest LVEF defined LVEF reserve. The Duke score was used to estimate the anatomic extent of jeopardized myocardium. Results: Regadenoson PET had a high sensitivity, 92% (95% confidence interval [CI], 83%–97%), in detecting obstructive CAD, with a normalcy rate of 97% (95% CI, 86%–99%), specificity of 77% (54/70 patients; 95% CI, 66%–86%), and area under the receiver-operator-characteristic curve of 0.847 (95% CI, 0.774–0.903; P < 0.001). Regadenoson PET demonstrated high sensitivity to detect CAD in patients with single-vessel CAD (89%; 95% CI, 70%–98%). The mean LVEF reserve was significantly higher in patients with normal myocardial perfusion imaging results (6.5% ± 5.4%) than in those with mild (4.3 ± 5.1, P = 0.03) and moderate to severe reversible defects (−0.2% ± 8.4%, P = 0.001). Also, mean LVEF reserve was significantly higher in patients with a low likelihood of CAD (7.2% ± 4.5%, P < 0.0001) and mild or moderate jeopardized myocardium than in those with significant jeopardized myocardium (score ≥ 6), −2.8% ± 8.3%. Conclusion: Regadenoson 82Rb myocardial perfusion imaging is accurate for the detection of obstructive CAD. LVEF reserve is high in patients without significant ischemia or significant angiographic jeopardized myocardium.
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Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).
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