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Defining the prognostic value of [15O]H2O positron emission tomography-derived myocardial ischaemic burden
Pepijn A van Diemen1, Jan-Thijs Wijmenga1, Roel S Driessen1
1Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Insights
This study identified prognostic thresholds for myocardial ischaemic burden (IB) in coronary artery disease (CAD) patients using [15O]H2O PET. A hyperaemic myocardial blood flow (hMBF) IB of 24% better predicted adverse outcomes than MFR IB.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Medical Diagnostics
Background:
- Myocardial ischaemic burden (IB) is crucial for risk stratifying patients with coronary artery disease (CAD).
- Quantitative [15O]H2O positron emission tomography (PET) provides a method to assess IB.
- Defining prognostic thresholds for PET-derived IB is essential for clinical application.
Purpose of the Study:
- To establish a prognostic threshold for quantitative [15O]H2O PET-derived myocardial ischaemic burden (IB).
- To evaluate the predictive value of IB thresholds for adverse cardiovascular events in patients with suspected or known CAD.
Main Methods:
- Included 623 patients with suspected or known CAD undergoing [15O]H2O PET perfusion imaging.
- Assessed hyperaemic myocardial blood flow (hMBF) and myocardial flow reserve (MFR)-derived IB.
- Followed patients for a composite endpoint of death and non-fatal myocardial infarction (MI).
Main Results:
- Identified prognostic thresholds: hMBF IB of 24% and MFR IB of 28%.
- High hMBF IB (≥24%) or MFR IB (≥28%) correlated with significantly worse outcomes (annualized event rates 2.8% and 2.4%, respectively).
- hMBF IB ≥24% was a stronger predictor than MFR IB ≥28%, and remained significant after adjustment for clinical factors.
Conclusions:
- A hyperaemic myocardial blood flow (hMBF) ischaemic burden (IB) threshold of 24% is a strong predictor of adverse outcomes in CAD patients.
- Myocardial flow reserve (MFR) IB threshold of 28% also predicts outcomes, though less strongly than hMBF IB.
- Classifying patients by concordant IB results aids in identifying low- and high-risk individuals.
Aims:
Myocardial ischaemic burden (IB) is used for the risk stratification of patients with coronary artery disease (CAD). This study sought to define a prognostic threshold for quantitative [15O]H2O positron emission tomography (PET)-derived IB.
Methods And Results:
A total of 623 patients with suspected or known CAD who underwent [15O]H2O PET perfusion imaging were included. The endpoint was a composite of death and non-fatal myocardial infarction (MI). A hyperaemic myocardial blood flow (hMBF) and myocardial flow reserve (MFR)-derived IB were determined. During a median follow-up time of 6.7 years, 62 patients experienced an endpoint. A hMBF IB of 24% and MFR IB of 28% were identified as prognostic thresholds. Patients with a high hMBF or MFR IB (above threshold) had worse outcome compared to patients with a low hMBF IB [annualized event rates (AER): 2.8% vs. 0.6%, P < 0.001] or low MFR IB [AER: 2.4% vs. 0.6%, P < 0.001]. Patients with a concordant high IB had the worst outcome (AER: 3.1%), whereas patients with a concordant low or discordant IB result had similar and low AERs of 0.5% and 0.9% (P = 0.953), respectively. Both thresholds were of prognostic value beyond clinical characteristics, however, only the hMBF IB threshold remained predictive when adjusted for clinical characteristics and combined use of the hMBF and MFR thresholds.
Conclusion:
A hMBF IB ≥24% was a stronger predictor of adverse outcome than an MFR IB ≥28%. Nevertheless, classifying patients according to concordance of IB result allowed for the identification of low- and high-risk patients.
