Sayed Ahmed, Al Rifai Mahmoud, Al-Mallah Mouaz
Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
J Nucl Med. 2025 Sep 2;66(9):1406-1411. doi: 10.2967/jnumed.125.269457.
Although there is strong evidence for the prognostic value of myocardial flow reserve (MFR), there are fewer data on the prognostic implications of its constituents: myocardial blood flow at rest (MBF) and stress (MBF). Consecutive patients undergoing Rb PET imaging with regadenoson stress testing at a tertiary care center between August 2019 and August 2024 were included in this study. The 2 coprimary outcomes were a composite of death or heart failure (HF) hospitalization and a composite of myocardial infarction (MI) or late revascularization. Multivariable Andersen-Gill Cox models with robust variance estimators were used to incorporate recurrent events. Outcomes were modeled as a smooth function of MBF and MBF, with restricted cubic splines to allow nonlinearity. The analysis included 8,131 consecutive patients (median age of 68 y; 46.1% were women; median follow-up of 520 d (interquartile range, 186-921 d), among whom 471 deaths, 828 HF hospitalizations, 164 MIs, and 429 late revascularizations occurred. After adjusting for the relevant covariates, an MFR of 2 achieved through a lower MBF was associated with a significantly lower incidence of death and HF hospitalization, whereas an MFR of 2 achieved through a greater MBF was associated with a significantly lower incidence of MI and late revascularization. Assessments of the partial χ statistic, which measures the importance of predictors, similarly confirmed that MBF was more important for predicting death or HF hospitalization whereas MBF was more important for predicting MI or late revascularization. Measurements of absolute myocardial blood flow offer complementary prognostic value to MFR. A diminished MBF may signal a greater risk of future ischemic outcomes, whereas an elevated MBF may signal a greater risk of future death or HF hospitalization.
尽管有强有力的证据表明心肌血流储备（MFR）具有预后价值，但关于其组成部分静息心肌血流量（MBF）和负荷心肌血流量（MBF）的预后意义的数据较少。本研究纳入了2019年8月至2024年8月期间在一家三级医疗中心接受Rb PET成像及雷加昔布负荷试验的连续患者。两个共同主要结局是死亡或心力衰竭（HF）住院的复合结局以及心肌梗死（MI）或晚期血运重建的复合结局。使用具有稳健方差估计量的多变量Andersen-Gill Cox模型纳入复发事件。结局被建模为MBF和MBF的平滑函数，采用受限立方样条以允许非线性。分析纳入了8131例连续患者（中位年龄68岁；46.1%为女性；中位随访520天（四分位间距，186 - 921天）），其中发生了471例死亡、828例HF住院、164例MI和429例晚期血运重建。在调整相关协变量后，通过较低的MBF实现的MFR为2与死亡和HF住院的发生率显著降低相关，而通过较高的MBF实现的MFR为2与MI和晚期血运重建的发生率显著降低相关。对测量预测因子重要性的偏χ统计量的评估同样证实，MBF对预测死亡或HF住院更重要，而MBF对预测MI或晚期血运重建更重要。绝对心肌血流量的测量为MFR提供了补充预后价值。MBF降低可能预示未来缺血性结局的风险更高，而MBF升高可能预示未来死亡或HF住院的风险更高。
