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THE PROGNOSTIC VALUE OF ABNORMAL REGADENOSON MYOPARDIAL PERFUSION IMAGING
A1112 JACC April 1, 2014 Volume 63, Issue 12
Non Invasive Imaging The Prognostic Value of Abnormal Regadenoson Myopardial Perfusion Imaging Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: SPECT Imaging: Focus on Vasodilators, Interpretation and Newer Applications Abstract Category: 16. Non Invasive Imaging: Nuclear Presentation Number: 1173-19 Authors: Gopal Ghimire, Davis Lester, Steven Bleich, Joshua Mckay, Jaekeong Heo, Ami Iskandrian, Fadi Hage, University of Alabama at Birmingham, Birmingham, AL, USA Background: Regadenoson (REGA), a new selective adenosine A (2A) receptor agonist, is now the most commonly widely used stress agent for myocardial perfusion imaging (MPI). Although the diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, the prognostic value of abnormal MPI is not well defined. Methods: 1400 patients (700 consecutive normal and 700 consecutive abnormal REG MPI studies were included. The perfusion defect size (PDS) on REGA MPI was divided in 4 categories: PDS 0: 0% of left ventricle (LV); PDS1:>0-10% LV; PDS2: >10-20% LV, PDS 3: >20% LV. The Ischemia was categorized as 1: 0% LV, 2: >0-10% LV, 3: >10% LV. Results: Of the 1400 patients (42% male, 37% diabetes, 21% with congestive heart failure, 26% with ESRD), 18% had MI, 23.5% underwent PCI and 19.6% underwent coronary artery bypass surgery within a mean follow up of 46.35 months( SD 17.77). The hazard of death was analyzed using Cox regression analysis correcting for 10 different variables including the preceding variables and LVEF. When compared to PDS 0, the hazard ratio of death was 1.24 (95% confidence interval (CI) 0.874-1.76) for PDS1, 1.45 ( 95% CI 1.06,1.99) for PDS2, 1.49 (95% CI 1.084,2.062) for PDS3 with p less than 0.001 (Figure). Similarly the hazard of death using ischemia ( category 2 and 3) was 1.473 ( 95% CI 1.116, 1.946) and 1.796 (95% CI 1.437,2.246). Conclusions: The hazard of death is low in patients with normal REGA MPI. However with worsening severity of PDS or ischemia on REGA MPI, the risk of death progressively accelerates.
Non Invasive Imaging The Prognostic Value of Abnormal Regadenoson Myopardial Perfusion Imaging Poster Contributions Hall C Sunday, March 30, 2014, 9:45 a.m.-10:30 a.m.
Session Title: SPECT Imaging: Focus on Vasodilators, Interpretation and Newer Applications Abstract Category: 16. Non Invasive Imaging: Nuclear Presentation Number: 1173-19 Authors: Gopal Ghimire, Davis Lester, Steven Bleich, Joshua Mckay, Jaekeong Heo, Ami Iskandrian, Fadi Hage, University of Alabama at Birmingham, Birmingham, AL, USA Background: Regadenoson (REGA), a new selective adenosine A (2A) receptor agonist, is now the most commonly widely used stress agent for myocardial perfusion imaging (MPI). Although the diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, the prognostic value of abnormal MPI is not well defined. Methods: 1400 patients (700 consecutive normal and 700 consecutive abnormal REG MPI studies were included. The perfusion defect size (PDS) on REGA MPI was divided in 4 categories: PDS 0: 0% of left ventricle (LV); PDS1:>0-10% LV; PDS2: >10-20% LV, PDS 3: >20% LV. The Ischemia was categorized as 1: 0% LV, 2: >0-10% LV, 3: >10% LV. Results: Of the 1400 patients (42% male, 37% diabetes, 21% with congestive heart failure, 26% with ESRD), 18% had MI, 23.5% underwent PCI and 19.6% underwent coronary artery bypass surgery within a mean follow up of 46.35 months( SD 17.77). The hazard of death was analyzed using Cox regression analysis correcting for 10 different variables including the preceding variables and LVEF. When compared to PDS 0, the hazard ratio of death was 1.24 (95% confidence interval (CI) 0.874-1.76) for PDS1, 1.45 ( 95% CI 1.06,1.99) for PDS2, 1.49 (95% CI 1.084,2.062) for PDS3 with p less than 0.001 (Figure). Similarly the hazard of death using ischemia ( category 2 and 3) was 1.473 ( 95% CI 1.116, 1.946) and 1.796 (95% CI 1.437,2.246). Conclusions: The hazard of death is low in patients with normal REGA MPI. However with worsening severity of PDS or ischemia on REGA MPI, the risk of death progressively accelerates.