Prognostic value of regadenoson stress myocardial perfusion imaging in patients with left bundle branch block or ventricular paced rhythm. J Nucl Cardiol 2021 Jun;28(3):967-977
Date
05/31/2019Pubmed ID
31144225DOI
10.1007/s12350-019-01762-4Scopus ID
2-s2.0-85066781993 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
BACKGROUND: Vasodilator stress myocardial perfusion imaging (MPI) is the provocative test of choice in patients with left bundle branch block (LBBB) or ventricular paced (V-paced) rhythm. The prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) in these patients has not been studied.
METHODS AND RESULTS: We conducted a retrospective cohort study of 562 patients [mean age, 69 ± 11 years; men, 53.3%] with LBBB (50.7%) or V-paced rhythm (49.3%) who underwent regadenoson stress SPECT-MPI. There were 321 (57.1%) subjects with abnormal MPI and 192 (34.2%) with myocardial ischemia. During a mean follow-up of 2.5 ± 1.9 years, 39 (6.9%) patients had a major adverse cardiac event (MACE), defined as cardiac death or myocardial infarction. The annualized MACE rate in patients with normal MPI was 0.9% (LBBB, 0.8%; V-paced, 1.0%). There was a significant stepwise increase in MACE rates with increasing burdens of perfusion abnormality (P < 0.001) and myocardial ischemia (P = 0.001). Increased risk with abnormal MPI [adjusted hazard ratio, 4.26; P = 0.001] and myocardial ischemia [adjusted hazard ratio, 2.70; P = 0.003] was independent of and incremental to important clinical covariates. Abnormal MPI and myocardial ischemia predicted MACE similarly in both LBBB and V-paced subgroups (interaction P values > 0.05).
CONCLUSION: In patients with LBBB and V-paced rhythm, regadenoson stress SPECT-MPI provides independent and incremental prognostic value in predicting adverse cardiac events.
Author List
Iskander F, Iskander M, Gomez J, Doukky RAuthor
Mina Iskander MBBS Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adenosine A2 Receptor AgonistsAged
Aged, 80 and over
Bundle-Branch Block
Cardiac Pacing, Artificial
Exercise Test
Female
Humans
Male
Middle Aged
Myocardial Ischemia
Myocardial Perfusion Imaging
Predictive Value of Tests
Prognosis
Purines
Pyrazoles
Retrospective Studies
Tomography, Emission-Computed, Single-Photon