The significance of post-stress decrease in left ventricular ejection fraction in patients undergoing regadenoson...

Area of Science:

• Cardiology
• Nuclear Cardiology
• Diagnostic Imaging

Background:

• The clinical significance of a post-stress decrease in left ventricular ejection fraction (LVEF) during regadenoson stress gated SPECT (GSPECT) myocardial perfusion imaging (MPI) remains unstudied.
• Assessing LVEF changes during stress MPI is crucial for understanding cardiac function and predicting outcomes.

Purpose of the Study:

• To investigate whether a post-stress decrease in LVEF during regadenoson stress GSPECT-MPI predicts severe/extensive coronary artery disease (CAD) or adverse clinical outcomes.
• To evaluate the diagnostic and prognostic value of LVEF changes in patients undergoing MPI before coronary angiography.

Main Methods:

• Retrospective analysis of consecutive patients undergoing rest/regadenoson stress GSPECT-MPI followed by coronary angiography within 6 months.
• LVEF change calculated as stress LVEF minus rest LVEF, with 5% and 10% decrease thresholds.
• Diagnostic cohort (793 subjects) and outcome cohort (929 subjects) analyzed for prediction of severe/extensive CAD and major adverse cardiac events.

Main Results:

• In the diagnostic cohort, LVEF change was not predictive of severe/extensive CAD (AUC=0.50, P=0.946).
• No significant difference in severe/extensive CAD rates was observed between patients with or without LVEF decrease, irrespective of MPI findings.
• In the outcome cohort, post-regadenoson stress LVEF decrease was not associated with increased risk of cardiac death, myocardial infarction, or revascularization.

Conclusions:

• A decrease in LVEF following regadenoson stress GSPECT-MPI is not a reliable predictor of severe/extensive CAD in patients undergoing coronary angiography.
• Post-stress LVEF decrease does not correlate with adverse clinical outcomes, regardless of myocardial perfusion imaging findings.