prognostic significance of post-stress reduction in left ventricular ejection fraction with adenosine stress in jordanian patients with normal myocardial perfusion

The significance of post-stress reduction in left ventricular ejection fraction (lvef) in patients with normal perfusion on adenosine stress/rest imaging remains controversial. consecutive patients who underwent 2-day adenosine gated stress/rest 99mtc-sestamibi imaging and had normal perfusion were analyzed. lvef was quantified at rest and 1 hour post-adenosine. patients were followed up for hard (cardiac death or nonfatal mi) and soft (coronary revascularization or congestive heart failure) cardiac events for 24.1 ± 11.0 months. of 560 patients included in the study, 135 (24.1%) had a post-stress reduction in lvef of ≥ 5%. rest lvef (p < 0.001), known history of cad (p = 0.01) and transient ischemic dilatation ratio (p = 0.02) were independent predictors of lvef reduction. event-free survivals were similar in patients with and without ≥ 5% lvef reduction (p = 0.8). the unadjusted hazard ratio (95% ci) for cardiac events for ≥ 5% lvef reduction was 1.09 (0.55-2.15), p = 0.81, while the hazard ratio adjusted for known history of cad, smoking, post-stress lvef and peak heart rate was 0.87 (0.44-1.75), p = 0.71. significant post-adenosine reduction in lvef occurs in about one-fourth of patients with normal perfusion but does not confer adverse prognosis compared with patients without such reduction.