TY - JOUR
T1 - Incremental prognostic value of digital positron emission tomography derived myocardial flow reserve
T2 - A prospective cohort study
AU - Ahmed, Ahmed Ibrahim
AU - Al Rifai, Mahmoud
AU - Alahdab, Fares
AU - Saad, Jean Michel
AU - Han, Yushui
AU - Alfawara, Moath Said
AU - Nabi, Faisal
AU - Mahmarian, John J.
AU - Al-Mallah, Mouaz H.
N1 - Funding Information:
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2023/1/15
Y1 - 2023/1/15
N2 - BACKGROUND: Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners.METHODS: Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters.RESULTS: The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell's C 0.77, p = 0.002).CONCLUSION: MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.
AB - BACKGROUND: Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners.METHODS: Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters.RESULTS: The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell's C 0.77, p = 0.002).CONCLUSION: MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.
KW - CFR
KW - MBF
KW - MFR
KW - PET
KW - Myocardial Perfusion Imaging/methods
KW - Prognosis
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Male
KW - Coronary Circulation/physiology
KW - Coronary Artery Disease/diagnostic imaging
KW - Fractional Flow Reserve, Myocardial
KW - Myocardium
KW - Female
KW - Aged
KW - Positron-Emission Tomography/methods
UR - http://www.scopus.com/inward/record.url?scp=85138997880&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85138997880&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2022.09.015
DO - 10.1016/j.ijcard.2022.09.015
M3 - Article
C2 - 36096273
AN - SCOPUS:85138997880
SN - 0167-5273
VL - 371
SP - 465
EP - 471
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -