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Published on: June 28, 2019
Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients
René A Tio1, Ali Dabeshlim, Hans-Marc J Siebelink
1Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Myocardial perfusion reserve (MPR) is a stronger predictor of cardiac death in ischemic heart disease (IHD) patients than left ventricular ejection fraction (LVEF). Low MPR indicates a high risk for cardiac mortality in IHD.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Left ventricular ejection fraction (LVEF) is a well-established prognostic indicator in ischemic heart disease (IHD).
- Myocardial perfusion reserve (MPR) is a key determinant of left ventricular function and survival in various cardiomyopathies.
- The prognostic value of MPR in IHD patients remains to be fully elucidated.
Purpose of the Study:
- To compare the prognostic capabilities of MPR and LVEF in patients with IHD.
- To determine if MPR is a significant predictor of survival in IHD.
Main Methods:
- 480 consecutive patients with chronic IHD underwent dipyridamole stress/rest 13N-ammonia PET for MPR assessment and 18F-FDG PET for viability and function.
- Patients were followed for all-cause mortality and major adverse cardiovascular events.
- MPR and LVEF were analyzed for their association with cardiac death and cardiovascular events.
Main Results:
- In 463 patients, MPR was measured (mean LVEF 35%±15%).
- After adjusting for age and sex, MPR showed a hazard ratio of 4.11 per SD decrease for cardiac death, compared to 2.76 for LVEF.
- Low MPR was significantly associated with increased risk of cardiac mortality.
Conclusions:
- Myocardial perfusion reserve (MPR) is a more sensitive predictor of cardiac death in IHD patients than LVEF.
- Patients with IHD and low MPR face a substantially elevated risk of cardiac mortality.
Unlabelled:
The purpose of this study was to compare the prognostic value of left ventricular ejection fraction (LVEF) and myocardial perfusion reserve (MPR) assessed with PET in patients with ischemic heart disease (IHD). Myocardial perfusion is the main determinant of left ventricular function in patients with IHD. The prognostic value of LVEF has been widely established. In addition, MPR determines survival in patients with hypertrophic and dilated cardiomyopathies. In the present study, we evaluated whether MPR also determines survival in patients with IHD.
Methods:
Between 1995 and 2003, 480 consecutive patients with chronic IHD underwent dipyridamole stress and rest 13N-ammonia PET to determine MPR. Additionally, 18F-FDG PET was performed for viability (mismatching defects), infarction (matching defects), and left ventricular function assessment. Patients were followed for all causes of mortality and major cardiovascular events.
Results:
In 463 of the 480 patients, valid MPR could be measured (368 men; mean age, 66+/-11 y; LVEF, 35%+/-15%). One hundred nineteen patients underwent a PET-driven revascularization (67 through percutaneous coronary intervention and 52 through coronary artery bypass grafting). The remaining 344 patients were the subject of this study. The overall MPR was 1.71+/-0.50 (intertertile boundaries, 1.49 and 1.84). After adjustment for age and sex, MPR was associated with a hazard ratio for cardiac death of 4.11 (95% confidence interval, 2.98-5.67) per SD decrease, whereas the risk for LVEF was 2.76 (2.00-3.82) per SD decrease.
Conclusion:
Patients with IHD with a low MPR are at high risk of cardiac death. MPR is a more sensitive predictor for cardiac death than is LVEF.
