Diagnostic accuracy of regadenoson stress echocardiography: concordance with gated-spect myocardial perfusion imaging
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ORIGINAL PAPER
Diagnostic accuracy of regadenoson stress echocardiography: concordance with gated-spect myocardial perfusion imaging Ignacio Iglesias‑Garriz1 · Javier Vara‑Manso1 · Ana Sevilla2 · Felix Corral1 · Jose A. Lastra1 · Eladio Rodríguez2 · Carmen Garrote1 · Samuel del Castillo1 · Carmen de la Fuente2 · Felipe Fernandez‑Vazquez1 Received: 27 June 2020 / Accepted: 18 September 2020 © Springer Nature B.V. 2020
Abstract Regadenoson Stress Echocardiography (RSE) can detect myocardial ischemia, and its diagnostic accuracy should be evaluated. We sought to investigate the agreement between RSE and gated-SPECT myocardial perfusion imaging (MPI) and appraise its diagnostic accuracy.Consecutive patients (n = 202) referred for non-invasive evaluation of myocardial ischemia, with (38.6%) or without a previous coronary artery disease (CAD) diagnosis, were enrolled. Both tests were performed simultaneously. Invasive coronary angiography (CA) is considered the gold standard. The mean age was 70.9 (9.8) years, and 59.9% were male. The prevalence of cardiovascular risk factors (arterial hypertension [81.7%], diabetes mellitus [37.6%], hypercholesterolemia [71.8%], and smoking [18.8%]) was high. Forty-four patients (21.8%) had a non-interpretable electrocardiogram, 15 (34.1%) of them were a result of ventricular paced-rhythm, while 29 (65.9%) were a result of advanced left ventricular branch block. The overall agreement between both diagnostic techniques was good: Gwet’s AC1 0.66 (CI95% 0.55 to 0.76), and it was higher in patients without a previous CAD diagnosis: 0.76 (CI95% 0.65 to 0.87). In the biased sample (those who underwent CA), RSE and nuclear study sensitivity was 0.50 and 0.78 and specificity was 0.75 and 0.75, respectively. We noted a dramatic reduction in sensitivity for RSE after debiasing (debiased sensitivity of 0.16), and the negative predictive value was similar to the biased and debiased samples. RSE is in strong agreement with gated-SPECT MPI. However, its low sensitivity and negative predictive value preclude its use as a bedside test to detect myocardial ischemia. Keywords Regadenoson · Heart · Ischemia · Agreement · SPECT
Introduction Regadenoson is the first pharmaceutical agent to act as a selective agonist of the adenosine A2A receptors[1]. Intravenous injection induces coronary vasodilation with a rapid onset of action (time to peak myocardial hyperemia is 20–40 s) and a short effect (2–3 min), and it is given as a fixed-bolus dose. It has a very good safety profile and its side effects can be readily reversed with aminophylline. Regadenoson has been approved as a stress agent for gatedSPECT (Single Photon Emission Computed Tomography) myocardial perfusion imaging (MPI) to detect ischemia * Ignacio Iglesias‑Garriz [email protected] 1
Department of Cardiology, Complejo Asistencial Universitario de Leon, 24071 Leon, Spain
Department of Nuclear Medicine, Complejo Asistencial Universitario de Leon, Leon, Spain
2
because it can induce a mismatch of blood flow in no
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