Sayed Ahmed, Al Rifai Mahmoud, Alwan Maria, Al-Mallah Mouaz H
Houston Methodist Academic Institute, Weill Cornell Medicine, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
Eur Heart J Cardiovasc Imaging. 2025 Jul 31;26(8):1333-1342. doi: 10.1093/ehjci/jeaf132.
Whether the prognostic value of resting myocardial blood flow (MBFrest) and myocardial flow reserve (MFR) is modified by a patient's ejection fraction (EF) has not been studied.
Consecutive patients undergoing stress/rest MPI using Rb-82 PET between 2019 and 2024 were included. The primary outcome was a composite of death and heart failure (HF) hospitalizations. Multivariable Andersen-Gill Cox models were used to assess the association with the primary outcome, adjusting for traditional risk factors and other PET parameters. Restricted cubic splines were used to allow non-linearity. The 50th percentile of MBFrest/MFR served as the reference, with the 25th and 75th percentiles representing low and high comparators respectively. A total of 8089 patients with a median follow-up of 519 days (IQR: 186-916 days), among whom 466 deaths and 819 HF hospitalizations ocurred. Both high MBFrest and low MFR were associated with an increased risk of the primary outcome (HRs of 1.39 [95% CI: 1.18-1.63] and 1.70 [95% CI: 1.41-2.04], respectively). There was a significant interaction with EF for both variables (P < 0.001), with greater prognostic value at higher EFs. At EFs of 40%, 50%, 60%, 70% the HRs for high vs. low MBFrest were 1.24, 1.61, 1.97, and 2.46, respectively and for low vs. high MFR were 1.57, 2.06, 2.59, and 3.13, respectively. Across the spectrum of EF, a higher MBFrest carried a greater risk of death or HF hospitalization at constant MFRs.
The prognostic value of MBFrest and MFR is much more apparent at higher EFs, with a high MBFrest (and/or low MFR) identfying patients with a much higher risk than would be predicted based on their EF alone.
静息心肌血流量（MBFrest）和心肌血流储备（MFR）的预后价值是否会因患者的射血分数（EF）而改变尚未得到研究。
纳入2019年至2024年间连续接受使用Rb - 82 PET的负荷/静息心肌灌注显像的患者。主要结局是死亡和心力衰竭（HF）住院的复合结局。使用多变量安德森-吉尔Cox模型评估与主要结局的关联，并对传统危险因素和其他PET参数进行调整。使用受限立方样条来考虑非线性。MBFrest/MFR的第50百分位数作为参考，第25和第75百分位数分别代表低和高比较组。共有8089例患者，中位随访519天（四分位间距：186 - 916天），其中发生466例死亡和819例HF住院。高MBFrest和低MFR均与主要结局风险增加相关（风险比分别为1.39 [95%置信区间：1.18 - 1.63]和1.70 [95%置信区间：1.41 - 2.04]）。这两个变量与EF均存在显著交互作用（P < 0.001），在较高EF时预后价值更大。在EF为40%、50%、60%、70%时，高MBFrest与低MBFrest相比的风险比分别为1.24、1.61、1.97和2.46，低MFR与高MFR相比的风险比分别为1.57、2.06、2.59和3.13。在整个EF范围内，在恒定的MFR下，较高的MBFrest导致死亡或HF住院的风险更高。
MBFrest和MFR的预后价值在较高EF时更为明显，高MBFrest（和/或低MFR）识别出的患者风险比仅根据其EF预测的风险高得多。
