Winther Simon, Rasmussen Laust Dupont, Karim Salma Raghad, Westra Jelmer, Dahl Jonathan Nørtoft, Søby Jacob Hartmann, Nissen Louise, Lomstein Fabian Bøgild, Würtz Morten, Sundbøll Jens Munch, Ejlersen June Anita, Mortensen Jesper, Tolbod Lars Poulsen, Søndergaard Hanne Maare, Hansson Nicolaj Christopher Lyng, Nyegaard Mette, Jensen Rebekka Vibjerg, Madsen Michael Alle, Christiansen Evald Høj, Gormsen Lars Christian, Böttcher Morten
Department of Cardiology (S.W., L.D.R., J.N.D., J.H.S., L.N., F.B.L., M.W., J.M.S., M.B.), Gødstrup Hospital, Herning, Denmark.
Institute of Clinical medicine, Aarhus University, Denmark (S.W., S.R.K., J.N.D., J.H.S., L.N., F.B.L., M.W., J.M.S., J.A.E., J.M., L.P.T., H.M.S., N.C.L.H., R.V.J., M.A.M., E.H.C., L.C.G., M.B.).
Circ Cardiovasc Imaging. 2025 Jun;18(6):e017479. doi: 10.1161/CIRCIMAGING.124.017479. Epub 2025 Apr 3.
Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (Rb) versus [O]HO (O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare Rb-PET versus O-water-PET head-to-head for diagnosing obstructive CAD.
The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both Rb-PET, O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements.
In total, 196/270 (73%) patients with suspected stenosis on CTA completed Rb-PET, O-water-PET, and ICA. Myocardial blood flow measurements from Rb-PET and O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of Rb-PET versus O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], =0.59; specificity 85% [76-91%] versus 77% [68-85%], =0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and Rb-PET and O-water-PET sensitivities increased to >85%.
For detection of obstructive CAD by PET myocardial perfusion imaging, Rb versus O-water have similar diagnostic performance.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04707859.
正电子发射断层扫描（PET）心肌灌注成像被推荐作为胸痛症状稳定患者的一线检查，以及冠状动脉计算机断层扫描血管造影（CTA）异常后的选择性二线检查。然而，使用铷-82（Rb）与[O]HO（O-水）是否会影响冠状动脉疾病（CAD）的诊断性能尚不清楚。本研究的目的是直接比较Rb-PET与O-水-PET对阻塞性CAD的诊断。
该研究纳入了连续1000例因CTA检查提示有阻塞性CAD症状而转诊的患者。基于CTA怀疑有狭窄的患者同时接受Rb-PET、O-水-PET检查，随后进行有创冠状动脉造影（ICA），包括三支血管的血流储备分数和冠状动脉血流储备测量。
共有196/270（73%）例CTA怀疑有狭窄的患者完成了Rb-PET、O-水-PET和ICA检查。Rb-PET和O-水-PET测得的静息心肌血流量相关性很强（ρ，0.62 - 0.69），但充血时仅为中度相关（ρ，0.41 - 0.59）。两种PET示踪剂测得的心肌血流储备与ICA冠状动脉血流储备之间仅显示出弱相关性（ρ，0.11 - 0.38）。196例患者中有86例（44%）被确定为血流动力学上阻塞性CAD，定义为ICA血流储备分数≤0.80。使用预先设定的临界值，Rb-PET与O-水-PET的诊断准确性相似（敏感性69% [58 - 78%] 对71% [60 - 80%]，P = 0.59；特异性85% [76 - 91%] 对77% [68 - 85%]，P = 0.12）。以ICA直径狭窄>70%作为参考，196例患者中只有48例（24%）有解剖学上严重的CAD，Rb-PET和O-水-PET的敏感性增加到>85%。
对于PET心肌灌注成像检测阻塞性CAD，Rb与O-水的诊断性能相似。
