Left ventricular ejection fraction, myocardial blood flow and hemodynamic variables in adenosine and regadenoson vasodilator 82-Rubidium PET

J Nucl Cardiol. 2021 Aug 13. doi: 10.1007/s12350-021-02729-0. Online ahead of print.

Abstract

Aims: In most Rubidium-(Rb)-positron emission tomography (PET) studies, dipyridamole was used as vasodilator. The aim was to evaluate vasodilator PET left ventricular ejection fraction (LVEF), myocardial blood flow (MBF), hemodynamics, and the influence of adenosine and regadenoson on these variables.

Methods and results: Consecutive patients (N = 2299) with prior coronary artery disease (CAD) or no prior CAD undergoing adenosine/regadenoson 82Rb-PET were studied and compared according to CAD status and normal/abnormal PET (summed stress score 0-3 vs. ≥4). Rest and stress LVEF differed significantly depending on CAD status and scan results. In patients with no prior CAD, rest/stress LVEF were 68% and 72%, in patients with prior CAD 60% and 63%. LVEF during stress increased 5 ± 6% in normal compared to 1 ± 8% in abnormal PET (P<0.001). Global rest myocardial blood flow(rMBF), stress MBF(sMBF) and myocardial flow reserve (sMBF/rMBF) were significantly higher in no prior CAD patients compared to prior CAD patients(1.3 ± 0.5, 3.3 ± 0.9, 2.6 ± 0.8 and 1.2 ± 0.4, 2.6 ± 0.8, 2.4 ± 0.8 ml/g/min, respectively, P<0.001) and in normal versus abnormal scans, irrespective of CAD status(no prior CAD: 1.4 ± 0.5, 3.5 ± 0.8, 2.8 ± 0.8 and 1.2 ± 0.8, 2.5 ± 0.8, 2.2 ± 0.7; prior CAD: 1.3 ± 0.4, 3.1 ± 0.8, 2.7 ± 0.8 and 1.1 ± 0.4, 2.3 ± 0.7, 2.2 ± 0.7 ml/g/min, respectively, P<0.001). LVEF and hemodynamic values were similar for adenosine and regadenoson stress. Stress LVEF ≥70% excluded relevant ischemia (≥10%) with a negative predictive value (NPV) of 94% (CI 92-95%).

Conclusions: Rest/stress LVEF, LVEF reserve and MBF values are lower in abnormal compared to normal scans. Adenosine and regadenoson seem to have similar effect on stress LVEF, MBF and hemodynamics. A stress LVEF ≥70% has a high NPV to exclude relevant ischemia.

背景: 在大多数铷-正电子断层扫描 (Rb-PET)中,双嘧达莫是常见的血管扩张剂。本研究目的是评估血管扩张剂腺苷和瑞加德松PET扫描时对左心室射血分数 (LVEF)、心肌血流量 (MBF)、血流动力学这些变量的影响。 方法与结果: 对接受腺苷/瑞加德松进行 82Rb-PET 的 2299 名连续就诊的疑似或已知冠状动脉疾病 (CAD)患者进行研究,并根据 CAD 状态和PET正常/异常(总负荷积分 0-3 与 ≥ 4)进行分组比较。 对CAD患者的状态和扫描结果分析可以发现静息和负荷状态下的LVEF显著不同。在疑似CAD患者中,静息/负荷状态下的LVEF分别为 68% 和73%,在既往CAD患者中静息/负荷状态下的LVEF分别为 60%和63%。PET正常组负荷LVEF增加5±6%,PET异常组LVEF增加 1±8% (p < 0.001)。疑似CAD组的整体静息心肌血流量(rest myocardial blood flow, rMBF)、负荷MBF(stress myocardial blood flow, sMBF)和心肌血流储备(sMBF/rMBF)显著高于既往CAD组(分别为 1.3±0.5、3.3±0.9、2.6±0.8和1.2±0.4、2.6±0.8、2.4±0.8 ml/g/min,p<0.001);与PET异常组比较,PET正常组的rMBF、sMBF和MFR明显增高,并且与CAD状态无关(无 CAD: 1.4±0.5、3.5±0.8、2.5±0.8和1.2±0.8, 2.5±0.8, 2.2±0.7 ml/g/min;确诊 CAD: 1.3±0.4,3.1±0.8,2.7±0.8和1.1±0.4,2.3±0.7,2.2 ±0.7ml/g/min, p<0.001)。腺苷和瑞加德松负荷的LVEF和血液动力学参数相似。负荷LVEF ≥70%排除相对缺血(面积≥10%)的阴性预测值(NPV)为94%(置信区间92-95%)。 结论: 与正常的PET扫描相比,LVEF、LVEF储备和MBF值在PET异常情况下降低。腺苷和瑞加德松对负荷 LVEF、MBF和血流动力学有相似的作用。负荷 LVEF ≥70% 对排除相对缺血具有高 NPV 。.

Keywords: 82Rubdium positron emission tomography; Adenosine; Coronary artery disease; Left ventricular ejection fraction; Myocardial blood flow; Nuclear imaging; PET; Regadenoson.