Yuka Otaki1, Mathews B Fish2, Robert J H Miller1,3, Mark Lemley2, Piotr J Slomka4. 1. Department of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Metro 203, Los Angeles, CA, 90048, USA. 2. Oregon Heart and Vascular Institute, Sacred Heart Medical Center, 3311 Riverbend Drive, Springfield, OR, 97477, USA. 3. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada. 4. Department of Imaging (Division of Nuclear Medicine) and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Metro 203, Los Angeles, CA, 90048, USA. slomkap@cshs.org.
Abstract
BACKGROUND: We hypothesized early post-stress left ventricular ejection fraction reserve (EFR) on solid-state-SPECT is associated with major cardiac adverse events (MACE). METHODS: 151 patients (70 ± 12 years, male 50%) undergoing same-day rest/regadenoson stress 99mTc-sestamibi solid-state SPECT were followed for MACE. Rest imaging was performed in the upright and supine positions. Early stress imaging was started 2 minutes after the regadenoson injection in the supine position and followed by late stress acquisition in the upright position. Total perfusion deficit (TPD) and functional parameters were quantified automatically. EFR, ∆end-diastolic volume (EDV), and end-systolic volume (ESV) were calculated as the difference between stress and rest values in the same position. EFR < 0%, ∆EDV ≥ 5 ml, or ∆ESV ≥ 5 ml was defined as abnormal. RESULTS: During the follow-up (mean 3.2 years), 28 MACE occurred (19%). In Kaplan-Meier analysis, there was a significantly decreased event-free survival in patients with early EFR < 0% (P = 0.004). Similarly, there was a decreased event-free survival in patients with ∆ESV ≥ 5 ml at early stress (P = 0.003). However, EFR, ∆EDV, and ∆ESV at late stress were not associated with MACE-free survival. Cox proportional hazards model adjusting for clinical information and stress TPD demonstrated that EFR, ∆EDV, and ∆ESV at early stress were significantly associated with MACE (P < 0.05 for all). CONCLUSIONS: Reduced early post-stress EFR on vasodilator stress solid-state SPECT is associated with MACE.
BACKGROUND: We hypothesized early post-stress left ventricular ejection fraction reserve (EFR) on solid-state-SPECT is associated with major cardiac adverse events (MACE). METHODS: 151 patients (70 ± 12 years, male 50%) undergoing same-day rest/regadenoson stress 99mTc-sestamibi solid-state SPECT were followed for MACE. Rest imaging was performed in the upright and supine positions. Early stress imaging was started 2 minutes after the regadenoson injection in the supine position and followed by late stress acquisition in the upright position. Total perfusion deficit (TPD) and functional parameters were quantified automatically. EFR, ∆end-diastolic volume (EDV), and end-systolic volume (ESV) were calculated as the difference between stress and rest values in the same position. EFR < 0%, ∆EDV ≥ 5 ml, or ∆ESV ≥ 5 ml was defined as abnormal. RESULTS: During the follow-up (mean 3.2 years), 28 MACE occurred (19%). In Kaplan-Meier analysis, there was a significantly decreased event-free survival in patients with early EFR < 0% (P = 0.004). Similarly, there was a decreased event-free survival in patients with ∆ESV ≥ 5 ml at early stress (P = 0.003). However, EFR, ∆EDV, and ∆ESV at late stress were not associated with MACE-free survival. Cox proportional hazards model adjusting for clinical information and stress TPD demonstrated that EFR, ∆EDV, and ∆ESV at early stress were significantly associated with MACE (P < 0.05 for all). CONCLUSIONS: Reduced early post-stress EFR on vasodilator stress solid-state SPECT is associated with MACE.
Authors: Kristopher D Knott; Andreas Seraphim; Joao B Augusto; Hui Xue; Liza Chacko; Nay Aung; Steffen E Petersen; Jackie A Cooper; Charlotte Manisty; Anish N Bhuva; Tushar Kotecha; Christos V Bourantas; Rhodri H Davies; Louise A E Brown; Sven Plein; Marianna Fontana; Peter Kellman; James C Moon Journal: Circulation Date: 2020-02-14 Impact factor: 29.690
Authors: Robert J H Miller; Tali Sharir; Yuka Otaki; Heidi Gransar; Joanna X Liang; Andrew J Einstein; Mathews B Fish; Terrence D Ruddy; Philipp A Kaufmann; Albert J Sinusas; Edward J Miller; Timothy M Bateman; Sharmila Dorbala; Marcelo Di Carli; Balaji K Tamarappoo; Damini Dey; Daniel S Berman; Piotr J Slomka Journal: J Nucl Med Date: 2021-03-12 Impact factor: 11.082