TY - JOUR
T1 - The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging
AU - Andrikopoulou, Efstathia
AU - AlJaroudi, Wael A.
AU - Farag, Ayman
AU - Lester, Davis
AU - Patel, Hiren
AU - Iskandrian, Ami E.
AU - Hage, Fadi G.
N1 - Funding Information:
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.
Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - 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.
AB - 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.
KW - Coronary artery disease
KW - Heart rate response
KW - Myocardial perfusion imaging
KW - Regadenoson
KW - Vasodilator stress
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U2 - 10.1007/s00259-016-3380-y
DO - 10.1007/s00259-016-3380-y
M3 - Article
C2 - 27079736
AN - SCOPUS:84963750633
SN - 1619-7070
VL - 43
SP - 1493
EP - 1502
JO - European Journal of Nuclear Medicine
JF - European Journal of Nuclear Medicine
IS - 8
ER -