title: Stress positron emission tomography is safe and can guide coronary revascularization in high-risk patients being considered for transcatheter aortic valve replacement.
abstract: 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.
  
  
  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.
  
  
  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 cm(2) 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.
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue: Desk J1, Cleveland, OH, 44195, USA, paul.cremer@gmail.com.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Cremer
authors.forename: Shaden
authors.initials: S
authors.lastname: Khalaf
authors.forename: Junyang
authors.initials: J
authors.lastname: Lou
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Manuel D
authors.initials: MD
authors.lastname: Cerqueira
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005080:Exercise Test / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D049268:Positron-Emission Tomography; D011687:Purines / Q000009:adverse effects; D011720:Pyrazoles / Q000009:adverse effects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson