Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
Institute of Biostructure and Bioimaging, CNR, Naples, Italy.
J Nucl Cardiol. 2023 Jun;30(3):1110-1117. doi: 10.1007/s12350-022-03144-9. Epub 2022 Nov 9.
The purpose of this study was to assess the prognostic value of cardiac Rb positron emission tomography (PET)/computed tomography (CT) imaging in patients with myocardial ischemia of nonobstructive coronary arteries (INOCA).
We retrospectively evaluated 311 INOCA patients who underwent rest stress Rb PET/CT. Cardiac end points were cardiac death, myocardial infarction, or late coronary revascularization. A parametric survival model was also used to identify how the variables influenced time to event.
During a median follow-up of 37 months (range 6-108), 23 (7%) cardiac events occurred. In patients with events total perfusion defect (TPD) was higher and myocardial flow reserve (MFR) lower compared to those without events (both P < .001). At multivariable Cox analysis, increased TPD (i.e., ≥ 5%) and reduced MFR (i.e., < 2) were predictors of events (both P < .001). At Weibull survival analysis, the highest probability of cardiac events and risk acceleration were observed in patients with both increased TPD and reduced MFR. Annualized event rate was higher in patients with reduced MFR compared to those with preserved MFR (P < .001).
In patients with INOCA, the combined evaluation of myocardial perfusion and coronary vascular function by Rb PET/CT is able to identify those at higher risk of cardiac events.
本研究旨在评估心脏 Rb 正电子发射断层扫描（PET）/计算机断层扫描（CT）成像在非阻塞性冠状动脉心肌缺血（INOCA）患者中的预后价值。
我们回顾性评估了 311 例接受静息应激 Rb PET/CT 的 INOCA 患者。心脏终点为心脏死亡、心肌梗死或晚期冠状动脉血运重建。还使用参数生存模型来确定变量如何影响事件发生时间。
在中位数为 37 个月（范围 6-108）的随访期间，发生了 23 例（7%）心脏事件。与无事件患者相比，发生事件的患者总灌注缺损（TPD）更高，心肌血流储备（MFR）更低（均 P<.001）。多变量 Cox 分析显示，增加的 TPD（即≥5%）和降低的 MFR（即<2）是事件的预测因素（均 P<.001）。在威布尔生存分析中，在 TPD 增加且 MFR 降低的患者中观察到心脏事件和风险加速的最高概率。与 MFR 正常的患者相比，MFR 降低的患者的年化事件发生率更高（P<.001）。
在 INOCA 患者中，Rb PET/CT 对心肌灌注和冠状动脉功能的联合评估能够识别出发生心脏事件风险较高的患者。
