Influence of adenosine and regadenoson on left ventricular ejection fraction, myocardial blood flow and hemodynamics in vasodilator 82-Rubidium PET. (20th July 2021)

• Record Type: Journal Article
• Authors: Frey, S; Honegger, U; Clerc, OF; Caobelli, F; Haaf, PH; Zellweger, MJ
• Is Part Of: European heart journal. Volume 22(2021)Supplement 3
• Publication Date: 2021-07-20
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeab111.065
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: None. Introduction: Most 82Rubidium-(Rb)-Positron emission tomography (PET) studies for myocardial perfusion, dipyridamole was used as vasodilator. Less data is available for adenosine and regadenoson. Purpose: Therefore, the aim was to evaluate the influence of adenosine and regadenoson on left ventricular ejection fraction (LVEF), myocardial blood flow (MBF) and hemodynamics in vasodilator 82Rb-PET. Methods: Consecutive patients (n = 2299) with suspected or known coronary artery disease (CAD) undergoing 82Rb-PET were studied and compared according to CAD status and normal/abnormal PET (abnormal defined as summed stress score ≥4). Differences between stress and rest values (LVEF, MBF, hemodynamics) were calculated. The threshold of stress LVEF able to exclude a relevant ischemia (as defined by ≥10% myocardium ischemic based on SDS score) was assessed. Results: Rest and stress LVEF differed significantly depending on CAD status and scan results. In patients with suspected CAD, rest/stress LVEF were 68 ± 12% and 73 ± 12% (p < 0.001), in patients with prior CAD 60 ± 14% and 63 ± 15% (p < 0.001). LVEF during stress increased 5 ± 6% in normal compared to 1 ± 8% in abnormal PET (p < 0.001). Global rest MBF (rMBF), stress MBF (sMBF) and myocardial flow reserve (sMBF/rMBF) were significantly higher in suspected CAD patients compared to prior CAD patients (1.3 ± 0.5, 3.3 ± 0.9, 2.6 ± 0.8 and 1.2 ± 0.4, 2.6 ± 0.8, 2.4 ± 0.8 ml/g/min, respectively, p < 0.001), and in normal versus abnormal scans, irrespective of CAD status (no CAD: 1.4 ± 0.5, 3.5 ± 0.8, 2.8 ± 0.8 and 1.2 ± 0.8, 2.5 ± 0.8, 2.2 ± 0.7; known CAD: 1.3 ± 0.4, 3.1 ± 0.8, 2.7 ± 0.8 and 1.1 ± 0.4, 2.3 ± 0.7, 2.2 ± 0.7 ml/g/min, respectively, p < 0.001). LVEF and hemodynamic values were similar for adenosine and regadenoson stress. Stress LVEF ≥70% excluded relevant ischemia with a negative predictive value (NPV) of 94% (CI 92-95%). Conclusions: Rest/stress LVEF, LVEF reserve and MBF values are lower in abnormal compared with normal scans. Adenosine and regadenoson seem to have similar effect on stress LVEF, MBF and hemodynamics. A stress LVEF ≥70% has a high NPV to exclude relevant ischemia.