Detection of Obstructive Coronary Artery Disease Using Regadenoson Stress and 82Rb PET/CT Myocardial Perfusion Imaging

Q: What are the key findings of this study?

Regadenoson 82Rb PET myocardial perfusion imaging detected obstructive CAD with 92% sensitivity, 77% specificity, and an AUC of 0.847.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected obstructive coronary artery disease (CAD) (n=134). Intervention: Regadenoson stress 82Rb PET/CT myocardial perfusion imaging vs. Invasive coronary angiography (reference standard for 96 patients) and low pretest likelihood of CAD (for 38 patients). Primary outcome: Diagnostic performance (sensitivity, specificity, normalcy rate, and ROC AUC) for detecting obstructive CAD (defined as >=50% left main stenosis or >=70% stenosis in other coronary arteries) (AUC 0.847 (Sensitivity 92%, Specificity 77%, Normalcy rate 97%), 95% CI 0.774-0.903, p=<0.001).

Q: What does this research mean for the field?

Regadenoson 82Rb myocardial perfusion PET imaging accurately detects obstructive coronary artery disease with 92% sensitivity, 77% specificity, and an area under the curve of 0.847. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Edward Hsiao; Bilal Ali; Ron Blankstein; Hicham Skali; Towhid Ali; John R. Bruyere; Raymond Y.K. Kwong; Marcelo F. Di Carli; Sharmila Dorbala

doi:10.2967/jnumed.113.120063

August 12, 2013Journal of Nuclear MedicineOpen Access

Detection of Obstructive Coronary Artery Disease Using Regadenoson Stress and 82Rb PET/CT Myocardial Perfusion Imaging

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Key result

Regadenoson 82Rb PET MPI detects obstructive CAD with ~92% sensitivity and 0.85 AUC.

AUC 0.847 (Sensitivity 92%, Specificity 77%, Normalcy rate 97%)
95% CI 0.774-0.903
P<0.001
n=134

Why the study?

The diagnostic performance of regadenoson 82Rb myocardial perfusion PET imaging for detecting obstructive CAD needed to be defined.

Does regadenoson stress with 82Rb PET/CT myocardial perfusion imaging accurately detect obstructive coronary artery disease in patients with suspected CAD?

Study Design

Type

Cohort (n=134)

Blinding

Blinded image interpretation (without knowledge of the angiographic results)

Multicenter

No

Structured PICO

Does regadenoson stress with 82Rb PET/CT myocardial perfusion imaging accurately detect obstructive coronary artery disease in patients with suspected CAD?

P

Population

134 adults with suspected coronary artery disease and no known prior CAD (mean age 63 years, mean BMI 31 kg/m2), including 96 who underwent invasive coronary angiography within 6 months and 38 with low pretest likelihood of CAD.

I

Intervention

Regadenoson stress (fixed-dose intravenous bolus) in conjunction with 82Rb PET/CT myocardial perfusion imaging (MPI)

C

Comparator

Invasive coronary angiography as reference standard (significant stenosis defined visually as ≥50% in left main or ≥70% in LAD, LCx, or RCA; ≥50% in any artery also tested) and low pretest likelihood of CAD (<10%) for normalcy rate

O

Outcome

Diagnostic accuracy (sensitivity, specificity, normalcy rate, and area under the ROC curve) of regadenoson 82Rb PET MPI for detecting obstructive CAD on invasive coronary angiography within 6 months (median 3 days)surrogate

Main Result

Effect estimate: AUC 0.847 (Sensitivity 92%, Specificity 77%, Normalcy rate 97%) (95% CI 0.774-0.903)

p-value: p=<0.001

Limitations

Single-center study with a relatively small cohort (96 patients with invasive angiographic correlation)
Pre- and posttest referral biases to coronary angiography based on clinical and imaging findings may have artificially inflated sensitivity and deflated specificity
Visual analysis of coronary stenosis and relative perfusion imaging were used instead of quantitative coronary angiography and absolute myocardial blood flow
Single-center study with a relatively small cohort (96 patients with invasive angiographic results)
Pre- and posttest referral biases to coronary angiography (7-fold higher referral in abnormal vs normal PET MPI) may have artificially inflated sensitivity and deflated specificity
Visual analyses of coronary stenosis percentage and relative perfusion imaging were used instead of quantitative coronary angiography and absolute myocardial perfusion

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Implication

This study establishes that regadenoson stress with 82Rb PET/CT myocardial perfusion imaging provides high diagnostic sensitivity (92%) and accuracy (AUC 0.847) for detecting obstructive CAD, while demonstrating that LVEF reserve is preserved in patients without significant ischemia or jeopardized myocardium.

Abstract

UNLABELLED: Our objective was to study the diagnostic performance of regadenoson (82)Rb myocardial perfusion PET imaging to detect obstructive coronary artery disease (CAD). METHODS: We studied 134 patients (mean age, 63 ± 12 y; mean body mass index, 31 ± 9 kg/m(2)) without known CAD (96 with coronary angiography and 38 with low pretest likelihood of CAD). Stress left ventricular ejection fraction (LVEF) minus rest LVEF defined LVEF reserve. The Duke score was used to estimate the anatomic extent of jeopardized myocardium. RESULTS: Regadenoson PET had a high sensitivity, 92% (95% confidence interval [CI], 83%-97%), in detecting obstructive CAD, with a normalcy rate of 97% (95% CI, 86%-99%), specificity of 77% (54/70 patients; 95% CI, 66%-86%), and area under the receiver-operator-characteristic curve of 0.847 (95% CI, 0.774-0.903; P < 0.001). Regadenoson PET demonstrated high sensitivity to detect CAD in patients with single-vessel CAD (89%; 95% CI, 70%-98%). The mean LVEF reserve was significantly higher in patients with normal myocardial perfusion imaging results (6.5% ± 5.4%) than in those with mild (4.3 ± 5.1, P = 0.03) and moderate to severe reversible defects (-0.2% ± 8.4%, P = 0.001). Also, mean LVEF reserve was significantly higher in patients with a low likelihood of CAD (7.2% ± 4.5%, P < 0.0001) and mild or moderate jeopardized myocardium than in those with significant jeopardized myocardium (score ≥ 6), -2.8% ± 8.3%. CONCLUSION: Regadenoson (82)Rb myocardial perfusion imaging is accurate for the detection of obstructive CAD. LVEF reserve is high in patients without significant ischemia or significant angiographic jeopardized myocardium.

Discussion

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Cite This Study

Hsiao et al. (2013) conducted a cohort in Suspected obstructive coronary artery disease (CAD) (n=134). Regadenoson stress 82Rb PET/CT myocardial perfusion imaging vs. Invasive coronary angiography (reference standard for 96 patients) and low pretest likelihood of CAD (for 38 patients) was evaluated on Diagnostic performance (sensitivity, specificity, normalcy rate, and ROC AUC) for detecting obstructive CAD (defined as >=50% left main stenosis or >=70% stenosis in other coronary arteries) (AUC 0.847 (Sensitivity 92%, Specificity 77%, Normalcy rate 97%), 95% CI 0.774-0.903, p=<0.001). Regadenoson 82Rb PET myocardial perfusion imaging detected obstructive CAD with 92% sensitivity, 77% specificity, and an AUC of 0.847.

synapsesocial.com/papers/6ac59d49c4fec44d3cd5eb85 https://doi.org/10.2967/jnumed.113.120063

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Detection of Obstructive Coronary Artery Disease Using Regadenoson Stress and 82Rb PET/CT Myocardial Perfusion Imaging

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Detection of Obstructive Coronary Artery Disease Using Regadenoson Stress and 82Rb PET/CT Myocardial Perfusion Imaging

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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