Abstract
PurposeTo assess the prognostic value of regional quantitative myocardial flow measures as assessed by 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD).MethodsWe retrospectively included 150 consecutive patients with suspected CAD who underwent clinically indicated 13 N-ammonia PET-MPI and who did not undergo revascularization within 90 days of PET-MPI. The presence or absence of a decreased global myocardial flow reserve (i.e., MFR < 2) as well as decreased regional MFR (i.e., ≥ 2 adjacent segments with MFR < 2) was recorded, and patients were classified as having preserved global and regional MFR (MFR group 1), preserved global but decreased regional MFR (MFR group 2), or decreased global and regional MFR (MFR group 3). We obtained follow-up regarding major adverse cardiac events (MACE, i.e., a combined endpoint including all-cause death, non-fatal myocardial infarction, and late revascularization) and all-cause death.ResultsOver a median follow-up of 50 months (IQR 38–103), 30 events occurred in 29 patients. Kaplan–Meier analysis showed significantly reduced event-free and overall survival in MFR groups 2 and 3 compared to MFR group 1 (log-rank: p = 0.015 and p = 0.013). In a multivariable Cox regression analysis, decreased regional MFR was an independent predictor for MACE (adjusted HR 3.44, 95% CI 1.17–10.11, p = 0.024) and all-cause death (adjusted HR 4.72, 95% CI 1.07–20.7, p = 0.04).ConclusionsA decreased regional MFR as assessed by 13 N-ammonia PET-MPI confers prognostic value by identifying patients at increased risk for future adverse cardiac outcomes and all-cause death.
Highlights
Ischemic heart disease remains the leading cause of death worldwide, and its prevalence is still increasing [1]
While global myocardial blood flow (MBF) may be impaired in patients with multi-vessel coronary artery disease (CAD) and those with microcirculatory dysfunction, it may remain largely unaffected in patients at less severe stages of CAD as the focal distribution of coronary artery lesions among the coronary artery tree may lead to only subtle regional differences in myocardial flow reserve (MFR)
A total of 185 patients who underwent 13N-ammonia PETMPI due to suspected CAD were identified from the registry
Summary
Ischemic heart disease remains the leading cause of death worldwide, and its prevalence is still increasing [1]. Several studies have demonstrated the prognostic value of absolute MBF values (hyperemic MBF or MFR) derived from PET-MPI [8,9,10,11,12,13,14]. European Journal of Nuclear Medicine and Molecular Imaging studies have focused on global MBF assessment, encompassing the entire myocardium. While global MBF may be impaired in patients with multi-vessel CAD and those with microcirculatory dysfunction, it may remain largely unaffected in patients at less severe stages of CAD as the focal distribution of coronary artery lesions among the coronary artery tree may lead to only subtle regional differences in MFR. We aim to assess the prognostic value of alterations in regional hyperemic MBF (hMBF) and MFR in patients with suspected CAD
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