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Thomas GS, Medina CA. Examining a novel threshold for defining electrocardiographic ischemia with vasodilator stress. J Nucl Cardiol 2020; 27:1533-1536. [PMID: 30390242 DOI: 10.1007/s12350-018-01491-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Gregory S Thomas
- MemorialCare Heart & Vascular Institute, 17360 Brookhurst Street, Southern California, CA, USA.
- Division of Cardiology, University of California, Irvine School of Medicine, Orange, CA, USA.
| | - Crystal A Medina
- Division of Cardiology, University of California, Irvine School of Medicine, Orange, CA, USA
- MemorialCare Heart & Vascular Institute, Long Beach Medical Center, Long Beach, CA, USA
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Doukky R, Nigatu A, Khan R, Anokwute C, Fughhi I, Ayoub A, Iskander F, Iskander M, Kola S, Sahyouni M, Karavolos K, Hota BN, Gomez J. Prognostic significance of ischemic electrocardiographic changes with regadenoson stress myocardial perfusion imaging. J Nucl Cardiol 2020; 27:1521-1532. [PMID: 30132187 DOI: 10.1007/s12350-018-1415-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients undergoing regadenoson SPECT myocardial perfusion imaging (MPI), the prognostic value of ischemic ST-segment depression (ST↓) and the optimal ST↓ threshold have not been studied. METHODS A retrospective cohort study of consecutive patients referred for regadenoson stress MPI was conducted. Patients with uninterpretable ECG were excluded. Two diagnostic thresholds of horizontal or downsloping ST↓ were studied, ≥ 0.5 mm and ≥ 1.0 mm. The primary endpoint was the composite major adverse cardiac events (MACE) of cardiac death, myocardial infarction, or coronary revascularization. RESULTS Among 8615 subjects (mean age 62 ± 13 years; 55% women), 89 (1.0%) had ST↓ ≥ 1.0 mm and 133 (1.5%) had ST↓ ≥ 0.5 mm. Regadenoson-induced ST↓ was more common in women (P < .001). Mean follow-up was 2.5 ± 2.2 years. After multivariate adjustment, ST↓ ≥ 1.0 mm was associated with a non-significant increase in MACE risk (P = .069), irrespective to whether MPI was abnormal (P = .162) or normal (P = .214). Ischemic ST↓ ≥ 0.5 mm was independently associated with MACE in the entire cohort (HR 2.14; CI 1.38-3.32; P = .001), whether MPI is normal (HR 2.07; CI 1.07-4.04; P = .032) or abnormal (HR 2.24; CI 1.23-4.00; P = .007), after adjusting for clinical and imaging covariates. An ST↓ threshold of ≥ 0.5 mm provided greater incremental prognostic value beyond clinical and imaging parameters (Δχ2 = 12.78; P < .001) than ≥ 1.0 mm threshold (Δχ2 = 3.72; P = .093). CONCLUSION Regadenoson-induced ischemic ST↓ is more common in women and it provides a modest independent prognostic value beyond MPI and clinical parameters. ST↓ ≥ 0.5 mm is a better threshold than ≥ 1.0 mm to define ECG evidence for regadenoson-induced myocardial ischemia.
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Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Abiy Nigatu
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Rozi Khan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Chiedozie Anokwute
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Ibtihaj Fughhi
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Ali Ayoub
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Fady Iskander
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Mina Iskander
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Snigdha Kola
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Mark Sahyouni
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Bala N Hota
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Javier Gomez
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Chicago, IL, 60612, USA
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The Significance of ST Depression in a Postmenopausal Woman on Estrogen Therapy during Regadenoson Myocardial SPECT Imaging. Case Rep Cardiol 2015; 2015:653760. [PMID: 25960892 PMCID: PMC4413522 DOI: 10.1155/2015/653760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
The incidence of false-positive stress tests has been noted in women, especially on hormone replacement therapy. Current literature describes this phenomenon in treadmill and adenosine stress tests. The introduction of regadenoson as a vasodilator agent has been widely adopted owing to its potency and specificity. To our knowledge, false-positive stress test with regadenoson in a postmenopausal woman on estrogen has never been described. Given the higher chronotropic response with regadenoson, we believe that normal perfusion images with a higher heart rate response indicate a good prognosis in such patients.
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