PT  - JOURNAL ARTICLE
AU  - Obeidat, Omar S.
AU  - Baniissa, Bayan
AU  - AlHouri, Abdullah
AU  - Alqaisi, Omar
AU  - Alrimawi, Omar
AU  - Akkawi, Mohammad
AU  - Zyad, Heba
AU  - Juweid, Malik
TI  - Prognostic significance of post-stress reduction in left ventricular ejection fraction with adenosine stress <sup>99m</sup>Tc-sestamibi in patients without reversible perfusion defects
DP  - 2019 May 01
TA  - Journal of Nuclear Medicine
PG  - 309--309
VI  - 60
IP  - supplement 1
4099  - http://jnm.snmjournals.org/content/60/supplement_1/309.short
4100  - http://jnm.snmjournals.org/content/60/supplement_1/309.full
SO  - J Nucl Med2019 May 01; 60
AB  - 309Objectives: The significance of post-stress reduction in left ventricular ejection fraction (LVEF) in patients who underwent an adenosine stress/rest study with no evidence of reversible perfusion defects remains controversial with only few studies comprising a large number of patients. The aim of this study is to determine the prognostic value of post-adenosine stress decrease in LVEF in these patients. Materials and Methods: We have identified all patients who had a two-day adenosine stress/rest 99mTc-sestamibi scan performed between 1/2015 and 10/2017 at Jordan University Hospital, no evidence of reversible perfusion defects and their rest and post-stress LVEF determined. LVEF was quantified at rest and 60 minutes post adenosine by QGS (Cedars-Sinai Medical Center, Los Angles, Calif.) Patients were then followed up for both hard (cardiac death or nonfatal myocardial infarction) and soft (coronary revascularization or congestive heart failure) cardiac events for a mean (± SD) of 24.2 ± 11.0 months. Results: Of the 636 patients who met the inclusion criteria, 562 (88.4%) had normal perfusion and 74 (11.6%) had fixed perfusion defects consistent with prior infarction. 152 of the 636 patients (23.9%) had ≥ 5% reduction in LVEF (mean ± SD =-7.6 ± 2.5%) and 484 (76.1%) had < 5% reduction in LVEF (1.4 ± 4.0%). Twelve of the 152 patients (7.9%) had cardiac events (7.9% soft, 0% hard) vs. 46 of the 484 patients (9.5%; 8.1% soft, 1.4% hard). No significant differences in the soft, hard or total cardiac event rates were found between the two groups (P=0.21-0.95). There were also no significant differences in cardiac event rates between patients with ≥ 10% vs those with < 10% reduction in LVEF (P=0.3-0.99) . Moreover, when the change in LVEF as continuous variable or as a cutoff decrease of 5% or 10% was entered into a logistic regression model including age, sex, tobacco use, diabetes mellitus, hypertension, dyslipidemia, known history of coronary artery disease (CAD), family history of CAD and myocardial perfusion pattern (normal vs. fixed defect), change in LVEF was not an independent predictor of cardiac events (P=0.34-0.50). Conclusions: Post-adenosine stress reduction in LVEF does not confer an adverse prognosis and is not an independent prognosticator in patients without reversible perfusion defects on 99mTc-sestamibi myocardial perfusion scan.