Ahmed Ahmed Ibrahim, Al Rifai Mahmoud, Alahdab Fares, Saad Jean Michel, Han Yushui, Alfawara Moath Said, Nabi Faisal, Mahmarian John J, Al-Mallah Mouaz H
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Int J Cardiol. 2023 Jan 15;371:465-471. doi: 10.1016/j.ijcard.2022.09.015. Epub 2022 Sep 10.
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.
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.
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).
MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.
正电子发射断层扫描（PET）心肌灌注成像（MPI）是疑似或已知冠状动脉疾病（CAD）患者一种可靠的诊断和预后检测方法。我们旨在使用最新一代数字PET扫描仪评估心肌血流储备（MFR）的增量预后价值。
纳入因疑似或已知CAD而进行临床指征性PET MPI的连续患者。从静息和充血高峰时的动态图像中获取以ml/min/g为单位的心肌血流量（MBF），并将心肌血流储备（MFR）计算为负荷与静息MBF的比值。从PET成像日期开始对患者进行随访，观察主要结局（全因死亡、心肌梗死以及成像后>90天发生的经皮冠状动脉介入治疗或冠状动脉旁路移植术的复合结局）的发生情况。采用嵌套多变量Cox回归模型评估MFR相对于传统危险因素和PET相对灌注参数的增量预后作用。
最终队列包括3534例患者（平均年龄67±12岁，48%为女性，67%为白种人，53%肥胖，55%患有高血压，32%患有糖尿病，42%患有血脂异常）。在中位随访8.5（3.0 - 15.4）个月期间，229例患者（6.5%，每1000人年6.4例）发生了主要结局。在嵌套多变量Cox模型中，MFR受损（MFR < 2）与主要结局显著相关（HR 2.9，95%CI 2.0 - 4.1，p < 0.001），并且显著改善了辨别能力（Harrell's C 0.77，p = 0.002）。
源自数字PET扫描仪的MFR在疑似或已知CAD患者中具有独立的增量预后作用。
