Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2019
Prognostic significance of post-stress reduction in left ventricular ejection fraction with adenosine stress in Jordanian patients with normal myocardial perfusion.
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Obeidat Omar S, Alhouri Abdullah, Baniissa Bayan, Alqaisi Omar, Akkawi Mohammad, Zyad Heba, Alrimawi Omar, Al Jabi Mira, Jaradat Saba, Jawabreh Hamza, Al-Batsh Odai, Alaraj Othman, Juweid Malik E
Аннотация
BACKGROUND: The significance of post-stress reduction in left ventricular ejection fraction (LVEF) in patients with normal perfusion on adenosine stress/rest imaging remains controversial.
METHODS: Consecutive patients who underwent 2-day adenosine gated stress/rest 99mTc-sestamibi imaging and had normal perfusion were analyzed. LVEF was quantified at rest and 1 hour post-adenosine. Patients were followed up for hard (cardiac death or nonfatal MI) and soft (coronary revascularization or congestive heart failure) cardiac events for 24.1 ± 11.0 months.
RESULTS: Of 560 patients included in the study, 135 (24.1%) had a post-stress reduction in LVEF of ≥ 5%. Rest LVEF (P < 0.001), known history of CAD (P = 0.01) and transient ischemic dilatation ratio (P = 0.02) were independent predictors of LVEF reduction. Event-free survivals were similar in patients with and without ≥ 5% LVEF reduction (P = 0.8). The unadjusted hazard ratio (95% CI) for cardiac events for ≥ 5% LVEF reduction was 1.09 (0.55-2.15), P = 0.81, while the hazard ratio adjusted for known history of CAD, smoking, post-stress LVEF and peak heart rate was 0.87 (0.44-1.75), P = 0.71.
CONCLUSIONS: Significant post-adenosine reduction in LVEF occurs in about one-fourth of patients with normal perfusion but does not confer adverse prognosis compared with patients without such reduction.
METHODS: Consecutive patients who underwent 2-day adenosine gated stress/rest 99mTc-sestamibi imaging and had normal perfusion were analyzed. LVEF was quantified at rest and 1 hour post-adenosine. Patients were followed up for hard (cardiac death or nonfatal MI) and soft (coronary revascularization or congestive heart failure) cardiac events for 24.1 ± 11.0 months.
RESULTS: Of 560 patients included in the study, 135 (24.1%) had a post-stress reduction in LVEF of ≥ 5%. Rest LVEF (P < 0.001), known history of CAD (P = 0.01) and transient ischemic dilatation ratio (P = 0.02) were independent predictors of LVEF reduction. Event-free survivals were similar in patients with and without ≥ 5% LVEF reduction (P = 0.8). The unadjusted hazard ratio (95% CI) for cardiac events for ≥ 5% LVEF reduction was 1.09 (0.55-2.15), P = 0.81, while the hazard ratio adjusted for known history of CAD, smoking, post-stress LVEF and peak heart rate was 0.87 (0.44-1.75), P = 0.71.
CONCLUSIONS: Significant post-adenosine reduction in LVEF occurs in about one-fourth of patients with normal perfusion but does not confer adverse prognosis compared with patients without such reduction.