The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date

Background Data on the prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) is limited and based on small cohorts. Methods and Results We conducted a single-center, retrospective cohort study of 10,275 consecutive patients who underwent regadenoson SPECT-MPI. Among the study subjects, 28.7% had abnormal MPI and 25.5% had myocardial ischemia. Patients were followed for a mean of 2.4 +/- 2.2 years for major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. There was a significant stepwise increase in MACE with an increasing burden of perfusion abnormality (P < .001) and myocardial ischemia (P < .001). Abnormal MPI (adjusted HR 1.52; 95% CI 1.21 to 1.91) and myocardial ischemia (adjusted HR 1.53; 95% CI 1.25 to 1.89) were associated with MACE, independent of and incremental to clinical covariates and left ventricular ejection fraction (LVEF). Moreover, post-stress LVEF, LVEF reserve, and left ventricular end-diastolic volume added significant prognostic information. Transient ischemic dilation >= 1.31 did not provide incremental prognostic value (adjusted HR 1.02; P = .906). Conclusion In the largest cohort to date, we demonstrated that the presence and severity of perfusion abnormality and myocardial ischemia on regadenoson stress SPECT-MPI are associated with an independent increase in MACE.

Automated summary

In a retrospective cohort study of 10,275 consecutive patients who underwent regadenoson SPECT-MPI, abnormal perfusion and myocardial ischemia were found to be independently associated with an increase in major adverse cardiac events. These findings suggest that regadenoson stress SPECT-MPI can provide valuable prognostic information for patients.