Prognostic implications of myocardial perfusion imaging by 82-rubidium positron emission tomography in male and female patients with angina and no perfusion defects

Abstract

Aims Myocardial perfusion imaging with 82-rubidium positron emission tomography (82Rb-PET) is increasingly used to assess stable coronary artery disease (CAD). We aimed to evaluate the prognostic value of 82Rb-PET-derived parameters in patients with symptoms suggestive of CAD but no significant reversible or irreversible perfusion defects. Methods and results Among 3726 consecutive patients suspected of stable CAD who underwent 82Rb-PET between January 2018 and August 2020, 2175 had no regional perfusion defects. Among these patients, we studied the association of 82Rb-PET-derived parameters with a composite endpoint of all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure, or ischaemic stroke. During a median follow up of 1.7 years (interquartile range 1.1–2.5 years), there were 148 endpoints. Myocardial blood flow (MBF) reserve (MFR), MBF during stress, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve, and Ca score were associated with adverse outcomes. In multivariable Cox model adjusted for patient and 82Rb-PET characteristics, MFR < 2 (hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.24–2.48), LVEF (HR 1.38 per 10% decrease, 95% CI 1.24–1.54), and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07–1.31) were significant predictors of endpoints. Results were consistent in subgroups defined by gender, history of ischaemic heart disease, low LVEF, and atrial fibrillation. Conclusion MFR, LVEF, and LVEF-reserve derived from 82Rb-PET provide prognostic information on cardiovascular outcomes in patients with no perfusion defects. This may aid in identifying patients at risk and might provide an opportunity for preventive interventions.

Impact of Isolated Coronary Microvascular Disease Diagnosed Using Various Measurement Modalities on Prognosis: An Updated Systematic Review and Meta-Analysis

“…Six studies, encompassing 9,507 subjects, presented HRs for mortality [5, 28, 31, 33, 34, 37]. The median follow-up period ranged from 1.6 to 12.5 years.…”

“…In this study, we expanded on previous meta-analysis [10,11] by including more recent studies [18,19,25,26,[31][32][33][34][35][36][37][38][39][40]. We have expanded our study population to include a greater number of Asian populations, such as those from China and Japan.…”

Interrelation between cardiac and brain small-vessel disease: a pilot quantitative PET and MRI study

“…Several cardiovascular imaging techniques have been proposed to assess microvascular dysfunction (Mathew et al 2020 ), including cardiac PET/CT. Some studies reported that MFR < 2 has a significant prognostic value in symptomatic women with non-obstructive CAD (Gulati et al 2009 ) as well as in patients without perfusion defect (Rauf et al 2022 ). Considering patients with no obstructive epicardial CAD, SVD patients represented 38/214 patients (17.8%), which is quite low compared to previous reports.…”

“…Considering patients with no obstructive epicardial CAD, SVD patients represented 38/214 patients (17.8%), which is quite low compared to previous reports. Indeed, Rauf et al ( 2022 ) recently reported in a large population that 27.9% of the patients ( N = 2175) with no significant perfusion defect on 82 Rb cardiac PET had a MFR < 2, while other authors even reported higher SVD prevalence up to 54% in patients without perfusion defect (Murthy et al 2014 ). While the authors did not report angiography results, they considered that low calcium score was likely indicative of low risk of triple-vessel CAD.…”

82Rb and [15O]H2O myocardial perfusion PET imaging: a prospective head to head comparison

“…Thus all [ 15 O]H 2 O PET scans were performed during the startup period. The center has a high-throughput with around 1,500 heart PET examinations per year 16 and during the startup period, a number of exams were co-reviewed by experts from Turku PET Centre to ensure quality. To increase the likelihood of ischemia in the cohort, we included patients with typical anginal chest pain and with at least one of the following risk factors: a family history of cardiac disease (< 55 years for male and < 65 years for female family members), smoking, diabetes, hypertension, BMI > 30 or hyperlipidemia.…”