Prognostic value of absent left ventricular ejection fraction reserve with regadenoson SPECT MPI
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Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United Kingdom Dept. of Radiology, University of Alabama in Birmingham, Birmingham, United Kingdom Division of Cardiovascular disease, Birmingham VA Medical Center, Birmingham, United Kingdom
Received May 4, 2020; accepted Sep 7, 2020 doi:10.1007/s12350-020-02390-z
Background. An absent left ventricular ejection fraction (LVEF) reserve with vasodilator stress with PET cardiac imaging has been shown to provide significant independent and incremental value to the perfusion images for prediction of future cardiovascular adverse events. However, the prognostic value of LVEF reserve has not been well characterized with SPECT myocardial perfusion imaging (MPI). Methods. We studied 858 consecutive patients with normal and abnormal perfusion pattern with regadenoson SPECT MPI. Change in LVEF was calculated as post-stress LVEF—rest LVEF. Absent LVEF reserve was defined as a drop in LVEF by 5% or more on the post-stress images. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction and late coronary revascularization. Results. An absent LVEF reserve was more common in patients with abnormal vs normal MPI (31% vs 19%, P = .001). During a median follow-up of 32 months, the primary outcome was experienced by 31% of the study population. An absent LVEF reserve was not associated with an increased risk of the primary outcome in patients with normal (hazard ratio 1.1, 95% CI .4-2.7, P = .8) or abnormal (.75, .56-1.00, P = .05) MPI. There was no significant correlation between extent of ischemia and post-stress change in LVEF (Pearson r = 2 .072, P = .07). Conclusions. In patients undergoing regadenoson SPECT MPI, absent LVEF reserve is not associated with worse cardiac outcomes. Thus, routine reporting of both post-stress and rest LVEF measurements in this setting may not be necessary. (J Nucl Cardiol 2020) Key Words: MPI Æ Gated SPECT Æ Diagnostic and prognostic application Æ Physiology of LV/RV function Æ CAD Æ Regadenoson
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Saurabh Malhotra, MD, MPH. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02390-z) contains supplementary material, which is available to authorized users.
Reprint requests: Fadi G. Hage, MD, MASNC, Division of Cardiovascular Disease, Dept. of Medicine, University of Alabama in Birmingham, Birmingham, United Kingdom; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Smith et al Prognostic value of absent LVEF reserve
Abbreviations CAD Coronary artery disease CR Coronary revascularization EDV End-diastolic
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