Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [15O] water positron emission tomography study

Abstract

Purpose We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [15O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD). Methods Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [15O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography. Results Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively). Conclusion In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [15O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.

Prognostic value of regional myocardial flow reserve derived from 13N-ammonia positron emission tomography in patients with suspected coronary artery disease

“…To our knowledge, only three studies have previously elaborated on the prognostic value of regional quantitative MBF parameters [25][26][27]:…”

“…Both Harjulahti et al and Bom et al previously found quantitative regional flow parameters to confer prognostic value for the prediction of myocardial infarction and death [ 26 , 27 ]. However, several methodological differences must be noted between the present and both previous studies.…”

Comparison of the prognostic value of impaired stress myocardial blood flow, myocardial flow reserve, and myocardial flow capacity on low-dose Rubidium-82 SiPM PET/CT

“…Myocardial perfusion imaging is a powerful noninvasive functional tool for risk stratification, recommended by clinical practice guidelines. [1][2][3][4][5] Compared with relative perfusion images, absolute quantification of myocardial blood flow (MBF) by positron emission tomography (PET) could improve risk stratification. 6 Global and regional perfusion provide information on different aspects of myocardial perfusion.…”

Comparison of the Prognostic Value of Global and Regional Myocardial Flow Capacity Radius, Myocardial Flow Reserve, and Stress Myocardial Blood Flow Using Rubidium-82 with SiPM PET/CT

“…Myocardial perfusion imaging is a powerful non-invasive functional tool for risk strati cation, recommended by clinical practice guidelines (1)(2)(3)(4)(5). Compared with relative perfusion images, absolute quanti cation of myocardial blood ow (MBF) and myocardial ow reserve (MFR) by positron emission tomography (PET) could improve risk strati cation (6).…”