Abstract
Myocardial flow reserve (MFR) derived from 13N-ammonia positron emission tomography (NH3-PET) can predict the prognosis of patients with various heart diseases. Coronary computed tomography angiography (CCTA) is a non-invasive investigation for ischemic heart disease. The coronary artery disease reporting and data system (CAD-RADS) was established to standardize and facilitate the reporting of CCTA data regarding CAD. This study aimed to investigate the prognostic value of CAD-RADS and MFR. A total of 133 patients who underwent NH3-PET and CCTA within 3months were enrolled. Patients were divided into groups with CAD-RADS 0-2 and ≥ 3 and into groups with MFR ≥ 2.0 and < 2.0. The endpoint was major adverse cardiac events (MACE) comprising all-cause death, acute coronary syndrome, hospitalization due to heart failure, and cerebrovascular disease. The ability of CAD-RADS and MFR to predict MACE was analyzed using Kaplan-Meier analysis. There was no significant difference in MFR between patients with CAD-RADS 0-2 and ≥ 3 (2.3 ± 0.9 vs. 2.2 ± 0.7, p = 0.50). The MACE rate for patients with CAD-RADS 0-2 and ≥ 3 was equivalent (log-rank test, p = 0.64). Patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.017). In patients with CAD-RADS ≥ 3, patients with MFR < 2.0 had a significantly higher MACE rate than those with MFR ≥ 2.0 (p = 0.034). CAD-RADS did not contribute to MACE prediction. Conversely, MFR was useful in predicting MACE, allowing for further risk stratification in addition to CAD-RADS.
Highlights
13N-ammonia positron emission tomography (NH3-PET) has high temporal and spatial resolutions [1]; it can evaluate myocardial blood flow (MBF) at rest, hyperemia-induced adenosine, myocardial flow reserve (MFR), and the ratio of MBF at stress to that at rest
There was no significant difference in MFR between patients with coronary artery disease (CAD)-RADS 0-2 and ≥3 (2.3±0.9 vs. 2.2±0.7, p=0.50)
This result suggests that it is useful to perform a functional assessment in patients with CAD-RADS ≥ 3
Summary
13N-ammonia positron emission tomography (NH3-PET) has high temporal and spatial resolutions [1]; it can evaluate myocardial blood flow (MBF) at rest, hyperemia-induced adenosine, myocardial flow reserve (MFR), and the ratio of MBF at stress to that at rest. The combination of MFR and myocardial perfusion imaging (MPI) is useful in diagnosing ischemic heart disease (IHD) [2,3]. MFR can predict the prognosis of patients with various heart diseases because low MFR (
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