Prognostic value of normal regadenoson stress perfusion cardiovascular magnetic resonance.

BACKGROUND: Regadenoson is a vasodilator stress agent that selectively activates the A2A receptor. Compared to adenosine, regadenoson is easier to administer and results in fewer side effects. Although extensively studied in patients undergoing nuclear perfusion imaging (MPI), its use for perfusion cardiovascular magnetic resonance (CMR) is not well described. The aim of this study was to determine the prognostic value of a normal regadenoson perfusion CMR in patients with known or suspected coronary artery disease. METHODS: Patients with known or suspected coronary artery disease were prospectively enrolled to receive perfusion CMR (Philips 1.5 T) with regadenoson. Three short-axis slices of the left ventricle (LV) were obtained during first pass of contrast using a hybrid GRE-EPI pulse sequence (0.075 mmol/kg Gadolinium-DTPA-BMA at 4 ml/sec). Imaging was performed 1 minute after injection of regadenoson (0.4 mg) and repeated 15 minutes after reversal of hyperemia with aminophylline (125 mg). Perfusion defects were documented if they persisted for ≥ 2 frames after peak enhancement of the LV cavity. CMR was considered abnormal if there was a resting wall motion abnormality, decreased LVEF (<40%), presence of LGE, or the presence of a perfusion defect during hyperemia. All patients were followed for a minimum of 1 year for major adverse cardiovascular event (MACE) defined as coronary revascularization, non-fatal myocardial infarction, and cardiovascular death. RESULTS: 149 patients were included in the final analysis. Perfusion defects were noted in 43/149 (29%) patients; 59/149 (40%) had any abnormality on CMR. During the mean follow-up period of 24 ± 9 months, 17/149 (11.4%) patients experienced MACE. The separation in the survival distributions for those with perfusion defects and those without perfusion defects was highly significant (log-rank p = 0.0001). When the absence of perfusion defects was added to the absence of other resting CMR abnormalities, the negative predictive value improved from 96% to 99%. CONCLUSION: Regadenoson perfusion CMR provides high confidence for excellent prognosis in patients with normal perfusion.

Long-term effects of hearing aids on word recognition scores.

OBJECTIVES: The purpose of this study was to retrospectively examine how monaurally fitted hearing aids affected word recognition scores in patients with bilateral symmetric sensorineural hearing loss. METHODS: Sixty-six patients from 2 separate institutions were included in this study. In addition to having bilateral symmetric sensorineural hearing loss due to presbycusis, each patient had to have worn a single hearing aid for at least 5 months and have valid pre-aid and post-aid audiograms. Word recognition scores were analyzed with a table of confidence levels generated by Thornton and Raffin that determined the probability of differences between word recognition scores. RESULTS: Hearing aids did not improve or preserve word recognition scores to the degree that has been previously reported in the literature. The unaided (control) ear demonstrated a decrease in word recognition scores over time, as was expected from previous studies. The aided ears demonstrated a similar decline in word recognition scores when compared to the unaided ears. When the conventional confidence level of 0.05 was used, the aided ears showed no advantage over the unaided (control) ears. CONCLUSIONS: These findings are not consistent with the acclimatization first reported by Silman et al in 1993. Such a discrepancy in the results calls for further studies to evaluate just how effective unilateral hearing aids are in patients with bilateral symmetric sensorineural hearing loss.