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Myocardial perfusion scintigraphy with adenosine: does it impair the left ventricular ejection fraction obtained with
Niels Brinkman1, Petra Dibbets-Schneider, Arthur J H A Scholte
1Department of Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Adenosine stress may negatively impact left ventricular ejection fraction (LVEF) in patients with normal myocardial perfusion scans. This finding suggests further investigation into adenosine
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Assessing left ventricular ejection fraction (LVEF) using gated SPECT.
- Evaluating myocardial perfusion scintigraphy (MPS) in patients.
Purpose of the Study:
- To determine if adenosine stress impairs LVEF in patients with normal MPS.
- Comparing adenosine stress to exercise stress in LVEF assessment.
Main Methods:
- Prospective study of 160 patients with normal MPS.
- Stress induced by exercise (n=64) or adenosine (n=96).
- Statistical analysis including t-tests, chi-tests, and linear regression.
Main Results:
- Adenosine stress resulted in a significant decrease in LVEF (-2.5%) compared to exercise stress (2.2% increase, P=0.001).
- A decrease in LVEF >5% was observed in 36.5% of patients under adenosine stress versus 15.6% under exercise stress (P=0.002).
- Adenosine was identified as an independent correlate of decreased LVEF (P=0.001).
Conclusions:
- Adenosine stress appears to impair LVEF measurements obtained via gated SPECT in patients with normal myocardial perfusion.
- Further research is needed to understand the mechanism and prognostic implications of this adenosine-induced LVEF reduction.
Background:
The aim of this study was to assess whether adenosine impairs left ventricular ejection fraction (LVEF) obtained with gated SPECT in patients with a normal myocardial perfusion scintigram.
Materials And Methods:
This prospective study included 160 consecutive patients with a normal myocardial perfusion scintigraphy (MPS), who were stressed with either exercise (n = 64) or with adenosine (n = 96). Student t-test or chi test was used to compare patient's characteristics and functional parameters. Linear regression analyses were used to assess which patient characteristics had an independent significant influence on LVEF.
Results:
Functional parameters at rest were not significantly different between the adenosine group and the exercise stress group. However at stress, these functional parameters were significantly different. LVEF in the adenosine group decreased by -2.5%, whereas in the exercise group LVEF increased by 2.2% (P = 0.001). Moreover, in 36.5% of the patients a decrease in the LVEF of more than 5% was observed in the group stressed with adenosine compared with 15.6% in the exercise group (P = 0.002). In regression analysis, adenosine (P = 0.001) was selected as an independent significant correlate of a decrease in LVEF.
Conclusion:
Adenosine seems to impair the LVEF obtained with gated SPECT in patients with a normal perfusion scintigram. Further evaluation is necessary to elucidate how adenosine exerts this effect and also, whether this finding has a prognostic value in patients with a normal perfusion scintigram.
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