TY - JOUR
T1 - Incremental prognostic value of positron emission tomography-derived myocardial flow reserve in patients with and without diabetes mellitus
AU - Aljizeeri, Ahmed
AU - Ahmed, Ahmed Ibrahim
AU - Suliman, Ihab
AU - Alfaris, Mousa Alali
AU - Elneama, Awadelkarim
AU - Al-Mallah, Mouaz H.
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - AIMS: We aimed to assess the incremental prognostic value of positron emission tomography (PET)-derived myocardial flow reserve (MFR) among patients with diabetes and those without diabetes.METHODS AND RESULTS: Consecutive patients with clinically indicated PET MPI for suspected or established coronary artery disease (CAD) were included. Myocardial blood flow (MBF) in mL/min/g was obtained from dynamic images at rest and stress, while 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 un-planned percutaneous coronary intervention/coronary artery bypass graft occurring more than 90 days after imaging). The final cohort consisted of 6019 patients (63% with diabetes) (mean age 61 ± 11 years, 45% female, 55% obese, 76% hypertensive, and 62% dyslipidaemia). Over half (53%) of the patients had an impaired MFR (<2). During a median follow-up of 22.6 (7.8-42.5) months, 619 patients (10%, 3.8 per 1000 person-years) experienced the primary outcome. Impaired MFR (MFR < 2) was significantly associated with the primary outcome in patients with and without diabetes (diabetes: HR 1.8, 95% CI 1.4-2.3, P < 0.001; no diabetes: 1.4, 95% CI 1.0-2.1, P = 0.046). There was no interaction between diabetes status and MFR (P = 0.234). Results were consistent across subgroups of patients with no CAD and normal perfusion study.CONCLUSION: PET-derived MFR has a strong independent and incremental prognostic role in patients with diabetes and those without diabetes.
AB - AIMS: We aimed to assess the incremental prognostic value of positron emission tomography (PET)-derived myocardial flow reserve (MFR) among patients with diabetes and those without diabetes.METHODS AND RESULTS: Consecutive patients with clinically indicated PET MPI for suspected or established coronary artery disease (CAD) were included. Myocardial blood flow (MBF) in mL/min/g was obtained from dynamic images at rest and stress, while 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 un-planned percutaneous coronary intervention/coronary artery bypass graft occurring more than 90 days after imaging). The final cohort consisted of 6019 patients (63% with diabetes) (mean age 61 ± 11 years, 45% female, 55% obese, 76% hypertensive, and 62% dyslipidaemia). Over half (53%) of the patients had an impaired MFR (<2). During a median follow-up of 22.6 (7.8-42.5) months, 619 patients (10%, 3.8 per 1000 person-years) experienced the primary outcome. Impaired MFR (MFR < 2) was significantly associated with the primary outcome in patients with and without diabetes (diabetes: HR 1.8, 95% CI 1.4-2.3, P < 0.001; no diabetes: 1.4, 95% CI 1.0-2.1, P = 0.046). There was no interaction between diabetes status and MFR (P = 0.234). Results were consistent across subgroups of patients with no CAD and normal perfusion study.CONCLUSION: PET-derived MFR has a strong independent and incremental prognostic role in patients with diabetes and those without diabetes.
KW - coronary microvascular dysfunction
KW - diabetes
KW - perfusion imaging
KW - positron emission tomography
KW - Coronary Circulation
KW - Myocardial Perfusion Imaging/methods
KW - Prognosis
KW - Humans
KW - Middle Aged
KW - Male
KW - Coronary Artery Disease
KW - Diabetes Mellitus
KW - Fractional Flow Reserve, Myocardial
KW - Myocardium
KW - Female
KW - Aged
KW - Positron-Emission Tomography/methods
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U2 - 10.1093/ehjci/jead023
DO - 10.1093/ehjci/jead023
M3 - Article
C2 - 36814411
AN - SCOPUS:85153803294
SN - 2047-2404
VL - 24
SP - 563
EP - 571
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 5
ER -