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21.08.2018 | Original Article

Prognostic significance of ischemic electrocardiographic changes with regadenoson stress myocardial perfusion imaging

Zeitschrift:
Journal of Nuclear Cardiology
Autoren:
MD, MSc, FASNC Rami Doukky, MD Abiy Nigatu, MD Rozi Khan, MD Chiedozie Anokwute, MD, MSc Ibtihaj Fughhi, MD Ali Ayoub, MD, MSc Fady Iskander, MD, MSc Mina Iskander, MD Snigdha Kola, Mark Sahyouni, MA Kelly Karavolos, MD Bala N. Hota, MD, MSc Javier Gomez
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12350-018-1415-4) contains supplementary material, which is available to authorized users.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Funding

The study was funded by a research grant from Astellas Pharma Global Development (Northbrook, IL).

Abstract

Background

In patients undergoing regadenoson SPECT myocardial perfusion imaging (MPI), the prognostic value of ischemic ST-segment depression (ST↓) and the optimal ST↓ threshold have not been studied.

Methods

A retrospective cohort study of consecutive patients referred for regadenoson stress MPI was conducted. Patients with uninterpretable ECG were excluded. Two diagnostic thresholds of horizontal or downsloping ST↓ were studied, ≥ 0.5 mm and ≥ 1.0 mm. The primary endpoint was the composite major adverse cardiac events (MACE) of cardiac death, myocardial infarction, or coronary revascularization.

Results

Among 8615 subjects (mean age 62 ± 13 years; 55% women), 89 (1.0%) had ST↓ ≥ 1.0 mm and 133 (1.5%) had ST↓ ≥ 0.5 mm. Regadenoson-induced ST↓ was more common in women (P < .001). Mean follow-up was 2.5 ± 2.2 years. After multivariate adjustment, ST↓ ≥ 1.0 mm was associated with a non-significant increase in MACE risk (P = .069), irrespective to whether MPI was abnormal (P = .162) or normal (P = .214). Ischemic ST↓ ≥ 0.5 mm was independently associated with MACE in the entire cohort (HR 2.14; CI 1.38-3.32; P = .001), whether MPI is normal (HR 2.07; CI 1.07-4.04; P = .032) or abnormal (HR 2.24; CI 1.23-4.00; P = .007), after adjusting for clinical and imaging covariates. An ST↓ threshold of ≥ 0.5 mm provided greater incremental prognostic value beyond clinical and imaging parameters (Δχ2 = 12.78; P < .001) than ≥ 1.0 mm threshold (Δχ2 = 3.72; P = .093).

Conclusion

Regadenoson-induced ischemic ST↓ is more common in women and it provides a modest independent prognostic value beyond MPI and clinical parameters. ST↓ ≥ 0.5 mm is a better threshold than ≥ 1.0 mm to define ECG evidence for regadenoson-induced myocardial ischemia.

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Zusatzmaterial
Supplementary material 1 (PPTX 815 kb)
12350_2018_1415_MOESM1_ESM.pptx
Supplementary material 2 (PDF 571 kb)
12350_2018_1415_MOESM2_ESM.pdf
Literatur
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