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

Maira Rauf, Kim W Hansen, Søren Galatius, Niels Wiinberg, Louise Scouborg Brinth, Signe Højstrup, Ulrik Talleruphuus, Eva Prescott

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.

Original languageEnglish
JournalEuropean Heart Journal Cardiovascular Imaging
Volume24
Issue number2
Pages (from-to)212-222
Number of pages11
ISSN1525-2167
DOIs
Publication statusPublished - 23 Jan 2023

Keywords

  • Angina Pectoris
  • Brain Ischemia
  • Coronary Artery Disease
  • Coronary Circulation/physiology
  • Female
  • Humans
  • Male
  • Myocardial Perfusion Imaging/methods
  • Positron-Emission Tomography/methods
  • Prognosis
  • Rubidium
  • Rubidium Radioisotopes
  • Stroke
  • Stroke Volume
  • Ventricular Function, Left

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