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Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Splenic switch-off (SSO) is a phenomenon describing a decrease in splenic radiotracer uptake after vasodilatory stress. We aimed to assess the diagnostic utility of regadenoson-induced SSO.

Methods

We included consecutive patients who had clinically indicated Regadenoson Rb-82 PET-MPI for suspected CAD. This derivation cohort (no perfusion defects and myocardial flow reserves (MFR) ≥ 2) was used to calculate the splenic response ratio (SRR). The validation cohort was defined as patients who underwent both PET-MPI studies and invasive coronary angiography (ICA).

Results

The derivation cohort (n = 100, 57.4 ± 11.6 years, 77% female) showed a decrease in splenic uptake from rest to stress (79.9 ± 16.8 kBq⋅mL vs 69.1 ± 16.2 kBq⋅mL, P < .001). From the validation cohort (n = 315, 66.3 ± 10.4 years, 67% male), 28% (via SRR = 0.88) and 15% (visually) were classified as splenic non-responders. MFR was lower in non-responders (SRR; 1.55 ± 0.65 vs 1.76 ± 0.78, P = .02 and visually; 1.18 ± 0.33 vs 1.79 ± 0.77, P < .001). Based on ICA, non-responders were more likely to note obstructive epicardial disease with normal PET scans especially in patients with MFR < 1.5 (SRR; 61% vs 34% P = .05 and visually; 68% vs 33%, P = .01).

Conclusion

Lack of splenic response based on visual or quantitative assessment of SSO may be used to identify an inadequate vasodilatory response.

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Abbreviations

CAD:

Coronary artery disease

PET:

Positron Emission Tomography

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

MPI:

Myocardial perfusion imaging

SSO:

Splenic switch-off

SSR:

Splenic response ratio

Rb:

Rubidium

HD:

Hemodynamics

ICA:

Invasive coronary angiography

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Disclosures

Dr Al-mallah receives research support from Siemense unrelated to this work. All other authors declare no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA

    Jean Michel Saad MD, Ahmed Ibrahim Ahmed MD MPH, Yushui Han MS, Lamees I. El Nihum BS, Fares Alahdab MD MSc, Faisal Nabi MD & Mouaz H. Al-Mallah MD MSc

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Saad, J.M., Ahmed, A.I., Han, Y. et al. Splenic switch-off in regadenoson 82Rb-PET myocardial perfusion imaging: assessment of clinical utility. J. Nucl. Cardiol. 30, 1484–1496 (2023). https://doi.org/10.1007/s12350-022-03158-3

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