Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging.

Abstract

AIMS:

We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with (82)Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia.

METHODS AND RESULTS:

Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan-Meier method in 318 patients after excluding 17 patients with early revascularizations (<60 days). Independent predictors of MACEs were identified by multivariate analysis. During a median follow-up of 624 days (inter-quartile range 540-697), 35 MACEs occurred. An annualized MACE rate was higher in patients with ischaemia (SDS >2) (n = 105) than those without [14% (95% CI = 9.1-22%) vs. 4.5% (2.7-7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11-25%) vs. 2.9% (1.2-7.0%) and 4.3% (2.1-9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2-22%) vs. 7.3% (4.2-13%) and 1.8% (0.6-5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia.

CONCLUSION:

Perfusion findings in (82)Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.

• Authors: Hoshang Farhad, Vincent Dunet, Kim Bachelard, Gilles Allenbach, Philipp A Kaufmann, John O Prior
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 14 Issue 12 Pg. 1203-10 (Dec 2013) ISSN: 2047-2412 [Electronic] England
• PMID: 23660750 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Rubidium Radioisotopes

Topics

• Aged
• Cohort Studies
• Coronary Artery Disease (diagnosis, diagnostic imaging)
• Coronary Circulation (physiology)
• Disease Progression
• Evaluation Studies as Topic
• Female
• Humans
• Image Enhancement
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (diagnosis, diagnostic imaging)
• Myocardial Ischemia (diagnosis, diagnostic imaging)
• Myocardial Perfusion Imaging (methods)
• Positron-Emission Tomography (methods)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Rubidium Radioisotopes
• Severity of Illness Index
• Statistics, Nonparametric
• Tomography, X-Ray Computed (methods)