Abstract
The role of vasodilator myocardial perfusion imaging (MPI) for aortic stenosis (AS) is controversial due to safety and accuracy concerns. In addition, its utility after aortic valve (AV) interventions remains unclear. Patients with AS who underwent thallium-201-gated dipyridamole MPI using a cadmium-zinc-telluride camera were retrospectively reviewed and divided into three groups: mild AS, moderate-to-severe AS, and prior AV interventions. Patients with coronary artery disease with ≥50% stenosis, severe arrhythmia, left ventricular ejection fraction (LVEF) <40%, left bundle branch block or no follow-up were excluded. Relationships between the severity of AS, clinical characteristics, hemodynamic response, serious adverse events (SAE) and MPI parameters were analyzed. None of the 47 patients had SAE, including significant hypotension or LVEF reduction. The moderate-to-severe AS group had higher summed stress scores (SSSs) and depressed LVEF than the mild AS group, however there were no differences after AV interventions. SSS was positively correlated with AV mean pressure gradient, post-stress lung-heart ratio (LHRs), and post-stress end-diastolic volume (EDVs) (P < 0.05). In multivariate analysis, LHRs and EDVs were independent contributors to SSS. Dipyridamole-induced ischemia and LV dysfunction is common, and dipyridamole stress could be a safe diagnostic tool in evaluation and follow-up in patients with AS.
Highlights
Aortic valve stenosis (AS) is the most common valvular disorder
The severity of aortic stenosis (AS) greatly improved after the intervention [aortic valve (AV) mean pressure gradient (PG) = 7.09 ± 4.62]
We demonstrate that increased lung to heart ratio (LHR) and left ventricular (LV) volumes contributed to dipyridamole-induced perfusion abnormalities
Summary
Aortic valve stenosis (AS) is the most common valvular disorder Clinical factors such as older age, male sex, smoking, hypertension, diabetes and hypercholesterolemia are important in the progression of AS1,2. Mortality is not significantly increased in patients with asymptomatic AS or in those who receive aortic valve (AV) interventions, whereas the mortality is high after the development of symptoms. There is increasing consensus on the management strategy for patients with coexisting transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI)[8], and single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), a non-invasive examination of last resort, may play an important role in this strategy, especially for those with high operative risk[9]. The role of vasodilator MPI in patients with significant AS is still controversial due to safety concerns and uncertainty www.nature.com/scientificreports/. The purpose of this study was to evaluate the efficacy and safety of dipyridamole stress SPECT MPI in patients with AS and after AV interventions
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