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Updated: Feb 7, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Is There an Age When Myocardial Perfusion Imaging May No Longer Be Prognostically Useful?
Fernanda Erthal1,2,3, Alomgir Hossain4, Sharmila Dorbala5,6
1Division of Cardiology, Department of Medicine (F.E., R.A.d., R.S.B.B., B.J.W.C.).
Insights
Positron emission tomographic (PET) myocardial perfusion imaging may offer diagnostic value in the elderly, but its prognostic value decreases in individuals 85 years and older. Further research is needed to evaluate its utility in this high-risk population.
Area of Science:
- Cardiology
- Nuclear Medicine
- Geriatrics
Background:
- Heart disease remains a leading cause of death, with increasing prevalence in aging populations.
- Understanding the clinical utility of medical tests in the elderly is crucial.
- Coronary artery disease risk escalates with age.
Purpose of the Study:
- To assess the incremental prognostic value of positron emission tomographic (PET) myocardial perfusion imaging.
- To specifically evaluate this value in the elderly population (≥85 years of age).
Main Methods:
- Analysis of 3343 patients from a multicenter observational PET registry.
- Patients categorized into age groups: 65-74.9, 75-84.9, and ≥85 years.
- Follow-up for all-cause mortality over a median of 3 years.
Main Results:
- The ≥85 age group (248 patients) had higher hypertension rates and lower dyslipidemia/diabetes incidence compared to younger cohorts.
- Left ventricular stress defect and ischemia predicted outcomes in patients <85 years but not in those ≥85 years.
- The prognostic value of PET imaging decreased with advancing age.
Conclusions:
- The elderly (≥85 years) are a high-risk group regardless of PET imaging results.
- The incremental prognostic value of PET myocardial perfusion imaging appears diminished in individuals ≥85 years.
- While potentially diagnostically useful, the prognostic utility of PET in the very elderly requires further investigation.
Background:
Heart disease continues to be the leading cause of death, and the prevalence of coronary artery disease is expected to increase as the population ages. It is important to understand the clinical utility of medical tests, or its lack thereof, in the aging population. The objective of this study was to understand the incremental prognostic value of positron emission tomographic (PET) myocardial perfusion imaging in the elderly (≥85 years of age).
Methods And Results:
A total of 3343 patients enrolled in a multicenter observational PET registry were analyzed. Participants were initially divided into 3 age categories: 65 to 74.9, 75 to 84.9, and ≥85 years of age and followed for all-cause death. Median follow-up time was 3 years. Of the total patient population, 248 patients (49% men) were ≥85 years old. When compared with younger patients, individuals ≥85 years had a higher prevalence of hypertension (79%) and a lower incidence of dyslipidemia (54%) and diabetes mellitus (24%). On multivariable analysis, %left ventricular stress defect and %left ventricular ischemia were predictors of patient outcome for those <85 years of age but was not statistically significant in those ≥85 years of age. The prognostic value of PET (%left ventricular stress defect and %left ventricular ischemia) appeared to decrease with advancing age.
Conclusions:
The elderly is a high-risk population irrespective of PET myocardial perfusion imaging results, and incremental prognostic value of PET myocardial perfusion imaging appears to wane in those ≥85 years of age. Although PET myocardial perfusion imaging may be diagnostically useful in the elderly, its prognostic value in this population requires further evaluation.
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