Stress positron emission tomography is safe and can guide coronary revascularization in high-risk patients being considered for transcatheter aortic valve replacement

Paul C. Cremer*, Shaden Khalaf, Junyang Lou, Leonardo Rodriguez, Manuel D. Cerqueira, Wael A. Jaber

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Methods: Fifty consecutive patients who were referred for consideration of TAVR and underwent a stress PET study were retrospectively identified. We assessed major adverse cardiac events and significant decreases in systolic blood pressure. The percentage of jeopardized myocardium was determined by combining ischemic and hibernating myocardium.

Background: The safety and accuracy of regadenoson stress positron emission tomography (PET) in patients with significant aortic stenosis (AS) is unknown. In patients undergoing surgical aortic valve replacement, coronary artery bypass grafting for coronary artery disease is standard, but the appropriate revascularization strategy in patients undergoing TAVR is uncertain. Stress PET may identify patients that benefit from revascularization.

Results: Our patients were high risk with a mean Society of Thoracic Surgeons mortality score of 11.4% and had severe AS with a moderately reduced left ventricular ejection fraction (EF) (mean aortic valve area of 0.78 ± 0.25 cm2 and mean EF of 39 ± 16%). There were no major adverse events during testing. Transient hypotension occurred in 16% of the patients. Revascularization was performed in 44% of patients, and 91% of these patients had revascularization to territories jeopardized on PET. These patients had substantial jeopardized myocardium (median 19%), and only 3 patients underwent revascularization despite less than 10% jeopardized myocardium.

Conclusions: Stress cardiac PET with regadenoson can be performed safely in patients with severe AS. Results of the PET study can accurately direct subsequent revascularization.

Original languageEnglish (US)
Pages (from-to)1001-1010
Number of pages10
JournalJournal of Nuclear Cardiology
Volume21
Issue number5
DOIs
StatePublished - Oct 1 2014

Keywords

  • Aortic stenosis
  • coronary artery disease
  • myocardial blood flow
  • myocardial perfusion imaging
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Fingerprint

Dive into the research topics of 'Stress positron emission tomography is safe and can guide coronary revascularization in high-risk patients being considered for transcatheter aortic valve replacement'. Together they form a unique fingerprint.

Cite this