无阻塞性冠状动脉疾病患者中心肌血流储备与校正心肌血流储备的预后价值。

Prognostic value of myocardial flow reserve vs corrected myocardial flow reserve in patients without obstructive coronary artery disease.

作者信息

Huck Daniel M, Weber Brittany N, Brown Jenifer M, Lopez Diana, Hainer Jon, Blankstein Ron, Dorbala Sharmila, Divakaran Sanjay, Di Carli Marcelo F

机构信息

From the Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

From the Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: https://twitter.com/@bweber04.

出版信息

J Nucl Cardiol. 2024 Jul;37:101854. doi: 10.1016/j.nuclcard.2024.101854. Epub 2024 Apr 7.

DOI:10.1016/j.nuclcard.2024.101854

PMID:38606610

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11257809/

Abstract

BACKGROUND

Myocardial flow reserve (MFR) by positron emission tomography (PET) is a validated measure of cardiovascular risk. Elevated resting rate pressure product (RPP = heart rate x systolic blood pressure) can cause high resting myocardial blood flow (MBF), resulting in reduced MFR despite normal/near-normal peak stress MBF. When resting MBF is high, it is not known if RPP-corrected MFR (MFR) helps reclassify CV risk. We aimed to study this question in patients without obstructive coronary artery disease (CAD).

METHODS

We retrospectively studied patients referred for rest/stress cardiac PET at our center from 2006 to 2020. Patients with abnormal perfusion (summed stress score >3) or prior coronary artery bypass grafting (CABG) were excluded. MFR was defined as stress MBF/corrected rest MBF where corrected rest MBF = rest MBF x 10,000/RPP. The primary outcome was major cardiovascular events (MACE): cardiovascular death or myocardial infarction. Associations of MFR and MFR with MACE were assessed using unadjusted and adjusted Cox regression.

RESULTS

3276 patients were followed for a median of 7 (IQR 3-12) years. 1685 patients (51%) had MFR <2.0, and of those 366 (22%) had an MFR ≥2.0 after RPP correction. MFR <2.0 was associated with an increased absolute risk of MACE (HR 2.24 [1.79-2.81], P < 0.0001). Among patients with MFR <2.0, the risk of MACE was not statistically different between patients with an MFR ≥2.0 compared with those with MFR <2.0 (1.9% vs 2.3% MACE/year, HR 0.84 [0.63-1.13], P = 0.26) even after adjustment for confounders (P = 0.66).

CONCLUSIONS

In patients without overt obstructive CAD and MFR< 2.0, there was no significant difference in cardiovascular risk between patients with discordant (≥2.0) and concordant (<2) MFR following RPP correction. This suggests that RPP-corrected MFR may not consistently provide accurate risk stratification in patients with normal perfusion and MFR <2.0. Stress MBF and uncorrected MFR should be reported to more reliably convey cardiovascular risk beyond perfusion results.

摘要

背景

正电子发射断层扫描（PET）测定的心肌血流储备（MFR）是一种经过验证的心血管风险测量指标。静息心率血压乘积（RPP = 心率×收缩压）升高可导致静息心肌血流量（MBF）增加，尽管峰值应激MBF正常/接近正常，但MFR仍会降低。当静息MBF较高时，尚不清楚经RPP校正的MFR（MFR）是否有助于重新分类心血管风险。我们旨在对无阻塞性冠状动脉疾病（CAD）的患者研究这一问题。

方法

我们回顾性研究了2006年至2020年在本中心接受静息/应激心脏PET检查的患者。排除灌注异常（应激总分>3）或既往有冠状动脉旁路移植术（CABG）的患者。MFR定义为应激MBF/校正后的静息MBF，其中校正后的静息MBF = 静息MBF×10,000/RPP。主要结局是主要心血管事件（MACE）：心血管死亡或心肌梗死。使用未调整和调整后的Cox回归评估MFR和MFR与MACE的关联。

结果

3276例患者的中位随访时间为7（IQR 3 - 12）年。1685例患者（51%）的MFR<2.0，其中366例（22%）经RPP校正后MFR≥2.0。MFR<2.0与MACE的绝对风险增加相关（HR 2.24 [1.79 - 2.81]，P<0.0001）。在MFR<2.0的患者中，MFR≥2.0的患者与MFR<2.0的患者相比，MACE风险在统计学上无差异（每年MACE发生率分别为1.9%和2.3%，HR 0.84 [0.63 - 1.13]，P = 0.26），即使在调整混杂因素后（P = 0.66）也是如此。