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The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The heart rate response (HRR, percentage change from baseline) to regadenoson during myocardial perfusion imaging (MPI) can provide incremental prognostic value in patients with known or suspected coronary artery disease. Our purpose was to evaluate the variability and prognostic value of HRR on serial measurements.

Methods

We studied 648 consecutive patients (61 ± 11 years, 48 % with diabetes) who underwent two regadenoson MPI studies (16 ± 9 months between studies). HRR <30 % was defined as abnormal. All-cause mortality was determined by chart review and verified using the US Social Security Death Master File.

Results

HRR was well correlated between the two studies (intraclass correlation coefficient 0.72, 95 % CI 0.67 – 0.76) with no systematic bias (mean difference 0.88 %, p = 0.2) or proportional bias (p = 0.5) by Bland-Altman analysis in all patients and in those with normal MPI on both studies. Of the 308 patients (48 %) with normal baseline HRR (HRR-1), 33 % had developed a blunted HRR on the second MPI study (HRR-2). Older age, male gender, end-stage renal disease, and abnormal baseline left ventricular ejection fraction were independent predictors of a new-onset abnormal HRR. During a mean follow-up of 2.4 ± 1.2 years, 55 patients (8.5 %) died. Patients with a blunted HRR-1 had increased mortality risk irrespective of their HRR-2 (p = 0.9, log-rank test). Among patients with normal HRR-1, a blunted HRR-2 was an independent predictor of all-cause mortality beyond clinical and traditional MPI data (hazard ratio 2.83, 95 % CI 1.14 – 7.03). Finally, patients with a normal HRR-1 and HRR-2 had the lowest event rate, while those with any abnormal HRR had an increased risk of death (hazard ratio 2.5, 95 % CI 1.2 – 5.4).

Conclusion

There was good correlation in the HRR to regadenoson on serial measurements without systematic or proportional biases. Patients with consistently normal HRR had the best prognosis.

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Abbreviations

CAD:

Coronary artery disease

HRR:

Heart rate response

LVEF:

Left ventricular ejection fraction

MPI:

Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

PDS:

Perfusion defect size

SPECT:

Single photon emission computed tomography

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Author notes

    Authors and Affiliations

    1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

      Efstathia Andrikopoulou, Ayman Farag, Davis Lester, Hiren Patel, Ami E. Iskandrian & Fadi G. Hage

    2. Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

      Efstathia Andrikopoulou & Fadi G. Hage

    3. Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon

      Wael A. AlJaroudi

    4. University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd AVE S, Birmingham, AL, 35294, USA

      Fadi G. Hage

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    1. Efstathia Andrikopoulou
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    3. Ayman Farag
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    Correspondence to Fadi G. Hage.

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    Conflicts of interest

    Dr. Hage reports grant funding from Astellas Pharma USA. Dr. Iskandrian is scientific advisor for Rapidscan Pharma. All other authors declare that they have no conflicts of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not describe any studies with animals performed by any of the authors.

    Additional information

    Efstathia Andrikopoulou and Wael A. AlJaroudi contributed equally to this work.

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    Andrikopoulou, E., AlJaroudi, W.A., Farag, A. et al. The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 43, 1493–1502 (2016). https://doi.org/10.1007/s00259-016-3380-y

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    • DOI: https://doi.org/10.1007/s00259-016-3380-y

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