Myocardial Perfusion Reserve After a PET-Driven Revascularization Procedure: A Strong Prognostic Factor

Abstract

Not all patients treated on the basis of PET-proven viability benefit from revascularization. Myocardial perfusion reserve (MPR) predicts survival in patients not undergoing revascularization. In the present study, we investigated whether MPR is related to survival in ischemic heart disease (IHD) patients after a PET-driven intervention. Methods: Between 1995 and 2003, 119 consecutive patients with chronic IHD underwent a PETdriven revascularization procedure based on ischemia-viability assessment with PET. Patients were followed for all-cause mortality and major cardiovascular events. Results: One hundred nineteen patients underwent a PET-driven revascularization procedure (67 percutaneous coronary interventions, 52 coronary artery bypass grafts) because of angina complaints. The mean age was 67 6 11 y (96 men, 23 women); global left ventricle MPR was 1.54 6 0.43. MPR intertertile boundaries were 1.34 and 1.67. Significantly more cardiac deaths were observed in the lowest and middle MPR tertiles than in the highest tertile. The age-and sex-corrected hazard ratio for the middle tertile was 8.3 (95% confidence interval, 1.02-68.3) and for the lowest tertile 23.6 (95% confidence interval, 3.1-179) (P 5 0.002). After left ventricular ejection fraction (LVEF) and viability were added to the model, MPR remained significant, with hazard ratios of 6.5 (0.8-54.4) and 18.5 (2.32145.5) (P 5 0.004), whereas neither LVEF nor viability reached significance in this model. Comparable results were found for major adverse cardiac events, with hazard ratios of 3.15 (0.82-12.0) and 8.24 (2.36-28.8) (P 5 0.002). Conclusion: Patients with IHD revascularized on the basis of PET viability assessment who have a low MPR are at risk for cardiac death and subsequent cardiac events. MPR is a more sensitive predictor for cardiac death than LVEF and extent of viability.

Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure

“…Slart et al reported that patients with low MFR (,1.34) had the poorest outcomes compared with the 2 other groups (MFR . 1.69 and 1.34-1.69) (25). Similarly, the results from this study showed that patients with low MBR-IR have poorer prognoses than patients with high MBR-IR.…”

Type 2 diabetes mellitus correlates with systolic function during myocardial stress perfusion scanning with Nitrogen-13 ammonia PET

“…Therefore, the influence of specific regional measures cannot be evaluated from this study alone. Finally, our population showed a discrete prevalence of DM2 patients, which might not concur with DM2 prevalence in patients referred to cardiac PET imaging; nevertheless, it portraits the prevalence in the general population as well as in previous published reports 13,14,18…”

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

“…46,49,50,53,[92][93][94] Consistently, patients with more severely reduced stress MBF and MFR are at higher risk than patients with preserved values or modest reductions. An analysis of the relationship between MFR and cardiac mortality suggests an excellent prognosis for an MFR of more than 2 and a steady increase in cardiac mortality for an MFR of less than 2 ( Figure 8).…”