Andrikopoulou Efstathia, AlJaroudi Wael A, Farag Ayman, Lester Davis, Patel Hiren, Iskandrian Ami E, Hage Fadi G
Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Eur J Nucl Med Mol Imaging. 2016 Jul;43(8):1493-502. doi: 10.1007/s00259-016-3380-y. Epub 2016 Apr 15.
The heart rate response (HRR, percentage change from baseline) to regadenoson during myocardial perfusion imaging (MPI) can provide incremental prognostic value in patients with known or suspected coronary artery disease. Our purpose was to evaluate the variability and prognostic value of HRR on serial measurements.
We studied 648 consecutive patients (61 ± 11 years, 48 % with diabetes) who underwent two regadenoson MPI studies (16 ± 9 months between studies). HRR <30 % was defined as abnormal. All-cause mortality was determined by chart review and verified using the US Social Security Death Master File.
HRR was well correlated between the two studies (intraclass correlation coefficient 0.72, 95 % CI 0.67 - 0.76) with no systematic bias (mean difference 0.88 %, p = 0.2) or proportional bias (p = 0.5) by Bland-Altman analysis in all patients and in those with normal MPI on both studies. Of the 308 patients (48 %) with normal baseline HRR (HRR-1), 33 % had developed a blunted HRR on the second MPI study (HRR-2). Older age, male gender, end-stage renal disease, and abnormal baseline left ventricular ejection fraction were independent predictors of a new-onset abnormal HRR. During a mean follow-up of 2.4 ± 1.2 years, 55 patients (8.5 %) died. Patients with a blunted HRR-1 had increased mortality risk irrespective of their HRR-2 (p = 0.9, log-rank test). Among patients with normal HRR-1, a blunted HRR-2 was an independent predictor of all-cause mortality beyond clinical and traditional MPI data (hazard ratio 2.83, 95 % CI 1.14 - 7.03). Finally, patients with a normal HRR-1 and HRR-2 had the lowest event rate, while those with any abnormal HRR had an increased risk of death (hazard ratio 2.5, 95 % CI 1.2 - 5.4).
There was good correlation in the HRR to regadenoson on serial measurements without systematic or proportional biases. Patients with consistently normal HRR had the best prognosis.
在心肌灌注成像（MPI）期间，瑞加诺生引起的心率反应（HRR，相对于基线的百分比变化）可为已知或疑似冠心病患者提供额外的预后价值。我们的目的是评估连续测量时HRR的变异性和预后价值。
我们研究了648例连续患者（61±11岁，48%患有糖尿病），这些患者接受了两次瑞加诺生MPI检查（两次检查间隔16±9个月）。HRR<30%被定义为异常。通过病历审查确定全因死亡率，并使用美国社会保障死亡主文件进行核实。
两次检查之间HRR具有良好的相关性（组内相关系数0.72，95%CI 0.67-0.76），在所有患者以及两次检查MPI均正常的患者中，Bland-Altman分析显示无系统偏差（平均差异0.88%，p=0.2）或比例偏差（p=0.5）。在308例（48%）基线HRR正常（HRR-1）的患者中，33%在第二次MPI检查（HRR-2）时出现HRR钝化。年龄较大、男性、终末期肾病以及基线左心室射血分数异常是新发异常HRR的独立预测因素。在平均2.4±1.2年的随访期间，55例患者（8.5%）死亡。HRR-1钝化的患者无论其HRR-2如何，死亡风险均增加（p=0.9，对数秩检验）。在HRR-1正常的患者中，HRR-2钝化是全因死亡率的独立预测因素，超越了临床和传统MPI数据（风险比2.83，95%CI 1.14-7.03）。最后，HRR-1和HRR-2均正常的患者事件发生率最低，而任何HRR异常的患者死亡风险增加（风险比2.5，95%CI 1.2-5.4）。
连续测量时瑞加诺生引起的HRR具有良好的相关性，无系统或比例偏差。HRR持续正常的患者预后最佳。
