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Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging

2013; Oxford University Press; Volume: 14; Issue: 12 Linguagem: Inglês

10.1093/ehjci/jet068

2047-2412

Hoshang Farhad, Vincent Dunet, K. Bachelard, Gilles Allenbach, Philipp A. Kaufmann, John O. Prior,

Advanced X-ray and CT Imaging

We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with 82Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia. Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan–Meier method in 318 patients after excluding 17 patients with early revascularizations ( 2) (n = 105) than those without [14% (95% CI = 9.1–22%) vs. 4.5% (2.7–7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11–25%) vs. 2.9% (1.2–7.0%) and 4.3% (2.1–9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2–22%) vs. 7.3% (4.2–13%) and 1.8% (0.6–5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia. Perfusion findings in 82Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.