Independent and incremental prognostic value of left ventricular ejection fraction determined by stress gated rubidium 82 PET imaging in patients with known or suspected coronary artery disease

Lertsburapa, Kirkeith; Ahlberg, Alan W.; Bateman, Timothy M.; Katten, Deborah; Volker, Lyndy; Cullom, S. James; Heller, Gary V.

doi:10.1016/j.nuclcard.2008.06.168

Cited by 114 publications

(34 citation statements)

References 33 publications

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“…Thus, it is possible to apply 82 Rb perfusion studies in larger populations [17][18]. However, there are limited data reported on MBF quantification using 82 Rb [19][20][21][22][23], and to our knowledge there has been no published data evaluating the MBF response during CPT to measure coronary endothelial function.…”

Section: Introductionmentioning

confidence: 99%

Quantitative analysis of coronary endothelial function with generator-produced 82Rb PET: comparison with 15O-labelled water PET

Yoshinaga

Manabe

Katoh

et al. 2010

Eur J Nucl Med Mol Imaging

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Section: Introductionmentioning

confidence: 99%

Quantitative analysis of coronary endothelial function with generator-produced 82Rb PET: comparison with 15O-labelled water PET

Yoshinaga

Manabe

Katoh

et al. 2010

Eur J Nucl Med Mol Imaging

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“…There is an abundance of available evidence about the risk of major adverse cardiovascular events after stress myocardial perfusion SPECT (17); more recent reports note similar findings for 82 Rb PET (37,38). The large body of literature demonstrates that as the extent and severity of perfusion abnormalities worsen, the ensuing major cardiac event rates increase; thus, there is a directly proportional relationship between stress perfusion abnormalities and prognosis ( Fig.…”

Section: Risk Stratification With Cardiac Imagingmentioning

confidence: 89%

“…In a cohort of 1,441 patients undergoing pharmacologic stress PET, annualized all-cause mortality rates were 2.4% for SSS of 0-3, 4.1% for SSS of 4-8, and 6.9% for SSS exceeding 8 (P , 0.001) (37). In a related series of 367 patients, annual cardiac event rates were 0.4%, 2.3%, and 7.0% for normal, mild, and moderate to severe stress 82 Rb PET findings, respectively (38).…”

Section: Prognostic Accuracy Of Stress Petmentioning

confidence: 98%

“…More recent data are available regarding prognosis predicted by 82 Rb PET (37,38). In a cohort of 1,441 patients undergoing pharmacologic stress PET, annualized all-cause mortality rates were 2.4% for SSS of 0-3, 4.1% for SSS of 4-8, and 6.9% for SSS exceeding 8 (P , 0.001) (37).…”

Section: Prognostic Accuracy Of Stress Petmentioning

confidence: 99%

“…Importantly, 82 Rb PET results provided improved risk stratification for obese patients and for patients after indeterminate SPECT results. Several series with 82 Rb PET perfusion noted a contribution to risk determination by the addition of measurement of changes in the ejection fraction, improving the identification of 3-vessel CAD (13,37).…”

Section: Prognostic Accuracy Of Stress Petmentioning

confidence: 99%

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Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Shaw

Narula²

2009

J Nucl Med

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This review highlights and compares risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and coronary CT angiography (CCTA). This review highlights an expansive evidence base for stress myocardial perfusion imaging and reveals a decided advantage for higher-risk patients, notably those who have established coronary artery disease (CAD). It is likely that the use of CCTA will continue to expand, particularly for patients with more atypical symptoms and patients with a lower likelihood of CAD. Despite a high level of evidence, comparative research is not available across modalities that could definitively drive utilization of cardiac imaging modalities. Evi dence about the accuracy of a variety of noninvasive imaging tests for the identification of at-risk patients with known and suspected coronary artery disease (CAD) has been evolving. Most of the early published research on noninvasive cardiology, from the 1980s and early 1990s, focused on the diagnostic accuracy of a test. More recent research has focused on evaluating the ensuing risk in patients with normal and abnormal cardiac imaging findings. Further exploration has been aimed at the graded or directly proportional relationships between the extent and the severity of imaging risk markers and major adverse cardiovascular events. These relationships highlight a common theme throughout the literature of ever-increasing and worsening cardiac event risk with more extensive and severe imaging abnormalities. More recent topics in the prognosis literature are the utility of new technology, such as coronary CT angiography (CCTA), and its accuracy compared with that of conventional testing, such as stress nuclear imaging. For this report, we compare risk assessment, predictive accuracy, and economic outcomes for 3 commonly applied cardiac imaging procedures: stress myocardial perfusion SPECT or PET and CCTA. We further highlight the potential value of hybrid imaging with PET/CT or even sequential imaging with SPECT plus CT. CORRELATION BETWEEN MYOCARDIAL ISCHEMIA AND CORONARY ANATOMYEarly research focused on the accuracy of stress nuclear imaging for detecting obstructive coronary stenosis. Lessons learned from these evaluations were that the detection of obstructive stenosis was related to the severity of the stenosis, collateral flow, and underlying endothelial function. Documentation of high rates of false-positive results (i.e., ischemia with no obstructive CAD) with stress myocardial perfusion may be related to vascular dysfunction, an early marker of atherosclerosis. In addition, normal stress perfusion results in patients with CAD are related to many factors, including collateral blood flow or prior coronary revascularization. It is for these reasons that much of the recent imaging research has focused on risk determination. However, for discussion purposes, it is helpful to understand the relationship between ischemia and coronary anatomy. INDUCIBLE ISCHEMIA D...

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Evaluating the Prognostic Value of Positron‐Emission Tomography Myocardial Perfusion Imaging Using Automated Software to Calculate Perfusion Defect Size

Williams

Dorn

LaMonte

et al. 2012

Clinical Cardiology

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Background: Myocardial perfusion imaging by positron-emission tomography (PET MPI) is regarded as a valid technique for the diagnosis of coronary artery disease (CAD), but the incremental prognostic value of PET MPI among individuals with known or suspected CAD is not firmly established. Hypothesis: Myocardial perfusion defect sizes as measured by PET MPI using automated software will provide incremental prognostic value for cardiac and all-cause mortality. Methods: This study included 3739 individuals who underwent rest-stress rubidium-82 PET MPI for the evaluation of known or suspected CAD. Rest, stress, and stress-induced myocardial perfusion defect sizes were determined objectively by automated computer software. Study participants were followed for a mean of 5.2 years for cardiac and all-cause mortality. Cox proportional hazards models were developed to evaluate the incremental prognostic value of PET MPI. Results: A strong correlation was observed between perfusion defect sizes assessed visually and by automated software (r = 0.76). After adjusting for cardiac risk factors, known CAD, noncoronary vascular disease, and use of cardioprotective medications, stress perfusion defect size was strongly associated with cardiac death (P < 0.001). Rest perfusion defects demonstrated a stronger association with cardiac death (P < 0.001) than stress-induced perfusion defects (P = 0.01), yet both were highly significant. Similar patterns held for all-cause death. Conclusions: The current study is the largest to date demonstrating PET MPI provides incremental prognostic value among individuals with known or suspected CAD. Automated calculation of perfusion defect sizes may provide valuable supplementary information to visual assessment.

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Independent and incremental prognostic value of left ventricular ejection fraction determined by stress gated rubidium 82 PET imaging in patients with known or suspected coronary artery disease

Abstract: EF assessed by stress gated Rb-82 PET imaging provides independent and incremental prognostic information and, hence, should be routinely incorporated in risk assessment.

Cited by 114 publications

References 33 publications

Quantitative analysis of coronary endothelial function with generator-produced 82Rb PET: comparison with 15O-labelled water PET

Quantitative analysis of coronary endothelial function with generator-produced 82Rb PET: comparison with 15O-labelled water PET

Risk Assessment and Predictive Value of Coronary Artery Disease Testing

Evaluating the Prognostic Value of Positron‐Emission Tomography Myocardial Perfusion Imaging Using Automated Software to Calculate Perfusion Defect Size

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