Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands.
Epidemiology & Data Science (J.W.R.T.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands.
Circ Cardiovasc Imaging. 2023 Sep;16(9):e014845. doi: 10.1161/CIRCIMAGING.122.014845. Epub 2023 Sep 19.
Coronary flow capacity (CFC) is a measure that integrates hyperemic myocardial blood flow and coronary flow reserve to quantify the pathophysiological impact of coronary artery disease on vasodilator capacity. This study explores the prognostic value of modified CFC derived from [O]HO positron emission tomography perfusion imaging.
Quantitative rest/stress perfusion measurements were obtained from 1300 patients with known or suspected coronary artery disease. Patients were classified as having myocardial steal (n=38), severely reduced CFC (n=141), moderately reduced CFC (n=394), minimally reduced CFC (n=245), or normal flow (n=482) using previously defined thresholds. The end point was a composite of death and nonfatal myocardial infarction.
During a median follow-up of 5.5 (interquartile range, 3.7-7.8) years, the end point occurred in 153 (12%) patients. Myocardial steal (hazard ratio [HR], 6.70 [95% CI, 3.21-13.99]; <0.001), severely reduced CFC (HR, 2.35 [95% CI, 1.16-4.78]; =0.018), and moderately reduced CFC (HR, 1.95 [95% CI, 1.11-3.41]; =0.020) were associated with worse prognosis compared with normal flow, after adjusting for clinical characteristics. Similarly, in the overall population, increased resting myocardial blood flow (HR, 3.05 [95% CI, 1.68-5.54]; <0.001), decreased hyperemic myocardial blood flow (HR, 0.68 [95% CI, 0.52-0.90]; =0.007) and decreased coronary flow reserve (HR, 0.55 [95% CI, 0.42-0.71]; <0.001) were independently associated with adverse outcome. In a model adjusted for the combined use of perfusion metrics, modified CFC demonstrated independent prognostic value (overall =0.017).
[O]HO positron emission tomography-derived resting myocardial blood flow, hyperemic myocardial blood flow, coronary flow reserve, and CFC are prognostic factors for death and nonfatal myocardial infarction in patients with known or suspected coronary artery disease. Importantly, after adjustment for clinical characteristics and the combined use of [O]HO positron emission tomography perfusion metrics, modified CFC remained independently associated with adverse outcome.
冠脉血流储备（CFC）是一种整合了充血性心肌血流和冠脉血流储备以量化冠状动脉疾病对血管扩张能力的病理生理影响的测量方法。本研究探讨了来源于[O]HO 正电子发射断层扫描灌注成像的改良 CFC 的预后价值。
对 1300 例已知或疑似冠心病患者进行定量静息/负荷灌注测量。患者根据先前定义的阈值分为心肌盗血（n=38）、严重 CFC 降低（n=141）、中度 CFC 降低（n=394）、轻度 CFC 降低（n=245）或正常血流（n=482）。终点是死亡和非致死性心肌梗死的复合终点。
在中位随访 5.5 年（四分位距，3.7-7.8 年）期间，153 例（12%）患者发生终点事件。与正常血流相比，心肌盗血（风险比[HR]，6.70[95%可信区间，3.21-13.99]；<0.001）、严重 CFC 降低（HR，2.35[95%可信区间，1.16-4.78]；=0.018）和中度 CFC 降低（HR，1.95[95%可信区间，1.11-3.41]；=0.020）与预后不良相关，校正临床特征后。同样，在总体人群中，静息心肌血流增加（HR，3.05[95%可信区间，1.68-5.54]；<0.001）、充血性心肌血流减少（HR，0.68[95%可信区间，0.52-0.90]；=0.007）和冠脉血流储备减少（HR，0.55[95%可信区间，0.42-0.71]；<0.001）与不良结局独立相关。在调整了灌注指标联合应用的模型中，改良 CFC 显示出独立的预后价值（总体=0.017）。
来源于[O]HO 正电子发射断层扫描的静息心肌血流、充血性心肌血流、冠脉血流储备和 CFC 是已知或疑似冠心病患者死亡和非致死性心肌梗死的预后因素。重要的是，在调整临床特征和[O]HO 正电子发射断层扫描灌注指标的联合应用后，改良 CFC 与不良结局仍独立相关。
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