N-氨正电子发射断层心肌灌注成像中心肌血流储备作为死亡率预后标志物的多中心评估
Multicenter Evaluation of Myocardial Flow Reserve as a Prognostic Marker for Mortality in N-Ammonia PET Myocardial Perfusion Imaging.
作者信息
Ramirez Giselle, Builoff Valerie, Miller Robert Jh, Lemley Mark, Carvajal-Juarez Isabel, Alexanderson Erick, Rosamond Thomas L, Song Na, Travin Mark I, Slipczuk Leandro, Einstein Andrew J, Wopperer Samuel, Di Carli Marcelo, Chareonthaitawee Panithaya, Slomka Piotr
机构信息
Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Cardiac Sciences, University of Calgary, Calgary AB, Canada.
出版信息
medRxiv. 2025 Jun 25:2025.06.24.25330229. doi: 10.1101/2025.06.24.25330229.
BACKGROUND
Myocardial flow reserve (MFR), measured by PET MPI, provides valuable information on epicardial coronary disease, diffuse atherosclerosis, and microvascular function. Despite its routine use, the prognostic efficacy of N-ammonia PET MFR remains unconfirmed in larger multicenter cohorts of patients with suspected or known coronary artery disease (CAD).
METHODS
We considered patients from five sites in the REFINE PET registry who underwent N-ammonia PET MPI for CAD. Clinical and imaging data were collected at the time of MPI. MFR was quantified as the ratio of stress to rest myocardial blood flow, using QPET software (Cedars-Sinai Medical Center, Los Angeles, CA). The primary outcome was all-cause mortality (ACM). Survival analyses were performed using Kaplan-Meier and Cox regression models adjusted for clinical and imaging covariates.
RESULTS
In total, 6277 patients were included (mean age of 64 years, 56% male). Median follow-up time was 3.8 years. There were 1895 patients with MFR ≤2 and 4382 with MFR >2. Patients with MFR ≤2 had significantly higher mortality than those with MFR >2 (n=701 [37.0%] vs. n=537 [12.3%], respectively; p<0.001). Annualized ACM rates by MFR and SSS ranged from 1.7 to 11.6. In multivariable analysis, MFR ≤2 was independently associated with increased ACM in the overall population (HR 2.70, 95% CI 2.41-3.03, p<0.001), even among patients with no perfusion defects (HR 2.36, 95% CI 1.93-2.89; p<0.001). Mortality risk decreased across increasing MFR deciles ranging from HR 2.73 (95% CI 2.39-3.11) to HR 0.35 (95% CI 0.25-0.49).
CONCLUSION
In this large multicenter cohort, MFR derived from N-ammonia PET MPI is a strong, independent predictor of ACM, even in patients with normal perfusion. An MFR of ≤2.0 identifies elevated risk, while higher values are associated with improved survival. These findings support the routine integration of MFR to enhance risk stratification in patients with suspected or known CAD.
背景
通过正电子发射断层心肌灌注显像（PET MPI）测量的心肌血流储备（MFR），可为心外膜冠状动脉疾病、弥漫性动脉粥样硬化和微血管功能提供有价值的信息。尽管其已被常规使用，但在更大规模的疑似或已知冠状动脉疾病（CAD）患者多中心队列中，N-氨PET MFR的预后疗效仍未得到证实。
方法
我们纳入了REFINE PET注册研究中五个地点因CAD接受N-氨PET MPI检查的患者。在MPI检查时收集临床和影像数据。使用QPET软件（加利福尼亚州洛杉矶市雪松西奈医疗中心）将MFR量化为应激与静息心肌血流量的比值。主要结局为全因死亡率（ACM）。使用Kaplan-Meier法和针对临床及影像协变量进行调整的Cox回归模型进行生存分析。
结果
总共纳入6277例患者（平均年龄64岁，56%为男性）。中位随访时间为3.8年。MFR≤2的患者有1895例，MFR>2的患者有4382例。MFR≤2的患者死亡率显著高于MFR>2的患者（分别为701例[37.0%]和537例[12.3%]；p<0.001）。按MFR和SSS计算的年化ACM率在1.7至11.6之间。在多变量分析中，MFR≤2在总体人群中与ACM增加独立相关（HR 2.70，95%CI 2.41-3.03，p<0.001），即使在无灌注缺损的患者中也是如此（HR 2.36，95%CI 1.93-2.89；p<0.001）。随着MFR十分位数的增加，死亡风险降低，范围从HR 2.73（95%CI 2.39-3.11）到HR 0.35（95%CI 0.25-0.49）。
结论
在这个大型多中心队列中，源自N-氨PET MPI的MFR是ACM的一个强大、独立的预测指标，即使在灌注正常的患者中也是如此。MFR≤2.0表明风险升高，而较高的值与生存改善相关。这些发现支持将MFR常规纳入以加强疑似或已知CAD患者的风险分层。
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