Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis View Full Text


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Article Info

DATE

2015-11

AUTHORS

Alessia Gimelli, Riccardo Liga, Michele Coceani, Angela Quaranta, Michele Emdin, Paolo Marzullo

ABSTRACT

AIMS: A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). METHODS AND RESULTS: One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: "Group 1" (HRR < 8 bpm; lowest tertile); "Group 2" (8 ≤ HRR ≤ 12 bpm; middle tertile); "Group 3" (HRR >12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74-0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole ("Group 1") MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR ("Group 3") (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to "Group 3" patients, while it disappeared in those with blunted HRR. CONCLUSIONS: In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD. More... »

PAGES

1903-1911

References to SciGraph publications

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  • 2000-08. Problems of Coronary Flow Reserve in ANNALS OF BIOMEDICAL ENGINEERING
  • 2014-12. The effect of beta blocker withdrawal on adenosine myocardial perfusion imaging in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2014-04. Long-term mortality following normal exercise myocardial perfusion SPECT according to coronary disease risk factors in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2013-12. Gated SPECT evaluation of left ventricular function using a CZT camera and a fast low-dose clinical protocol: comparison to cardiac magnetic resonance imaging in EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
  • 2014-04. Prognostic significance of impaired chronotropic response to pharmacologic stress Rb-82 PET in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2000-09. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality in JOURNAL OF NUCLEAR CARDIOLOGY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00259-015-3129-z

    DOI

    http://dx.doi.org/10.1007/s00259-015-3129-z

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1016623768

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/26194718


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