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

Our objectivewas to study the diagnostic performance of regadenoson 82Rb myocardial perfusion PET imaging to detect obstructive coro-nary artery disease (CAD).Methods:We studied 134 patients (mean age, 636 12 y; mean body mass index, 316 9 kg/m2) 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 ana-tomic extent of jeopardizedmyocardium.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 % 6 5.4%) than in those with mild (4.3 6 5.1, P 5 0.03) and moderate to severe reversible defects (20.2 % 6 8.4%, P 5 0.001). Also, mean LVEF reservewas significantly higher in patients with a low likelihood of CAD (7.2 % 6 4.5%, P, 0.0001) and mild or moderate jeopardizedmyocardium than in thosewith significant jeopardizedmyo-cardium (score $ 6), 22.8 % 6 8.3%. Conclusion: Regadenoson 82Rb 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