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Updated: Oct 3, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Relationship Between Myocardial Perfusion Imaging Abnormalities on Positron Emission Tomography and Anginal Symptoms,
Krishna K Patel1,2,3, Femina S Patel1, Timothy M Bateman1,2
1Saint Luke's Mid America Heart Institute, Kansas City, MO (K.K.P., F.S.P., T.M.B., K.F.K., P.A.P.-O., A.I.M., B.W.S., R.C.T., I.M.S., P.G.J., J.A.S.).
Background:
Myocardial perfusion imaging (MPI) identifies abnormalities that occur early in the ischemic cascade leading to angina. Our aim was to study the association between ischemic measures on positron emission tomography MPI and patients' health status; their symptoms, function, and quality of life.
Methods:
Health status was collected using the Seattle Angina Questionnaire (SAQ-7, 0-100, higher=better) and Rose Dyspnea Score (RDS) on 1515 outpatients with known or suspected coronary artery disease presenting for clinically indicated pharmacological 82Rb positron emission tomography MPI from July 2018 to July 2019. Adjusted multivariable ordinal regression models were used to assess the association between MPI findings of ischemia and the SAQ physical limitation, angina frequency, quality of life, summary score, and the RDS.
Results:
The mean SAQ and RDS scores of the cohort (mean age 71.7 years, 55% male, 37.6% prior myocardial infarction or revascularization) were 73.8±28.6 (physical limitation), 87.4±21.7 (angina frequency), 79.0±26.1 (quality of life), 81.3±19.0 (summary score), and 2±2 (RDS). No perfusion, flow or function abnormalities were significantly associated with SAQ angina frequency scores. Low left ventricular ejection fraction reserve (≤0%), low global and regional myocardial blood flow reserve (<2) were independently associated with worse SAQ Physical Limitation score, SAQ summary score, and RDS (30% to 57% greater odds; all P≤0.01), but reversible perfusion defects were not.
Conclusions:
Impaired augmentation of left ventricular ejection fraction and myocardial blood flow with stress is associated with significant angina-associated functional limitation, health status, and dyspnea in patients who underwent positron emission tomography MPI, but not the frequency of their angina. Future studies should evaluate whether therapies that improve stress-induced abnormalities in systolic function and myocardial flow may improve patients' health status.
Insights
Positron emission tomography myocardial perfusion imaging (MPI) reveals that impaired stress-induced blood flow and ejection fraction reserve are linked to worse health status and functional limitations in patients with coronary artery disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Myocardial perfusion imaging (MPI) detects early ischemic changes preceding angina.
- Understanding the link between MPI-derived ischemia and patient health status is crucial for managing coronary artery disease (CAD).
Purpose of the Study:
- To investigate the association between quantitative ischemic measures from positron emission tomography MPI and patient-reported health status, including symptoms, function, and quality of life.
Main Methods:
- 1515 outpatients with suspected CAD underwent pharmacological 82Rb positron emission tomography MPI.
- Health status was assessed using the Seattle Angina Questionnaire (SAQ-7) and Rose Dyspnea Score (RDS).
- Multivariable regression models analyzed the relationship between MPI findings and SAQ/RDS scores.
Main Results:
- Low left ventricular ejection fraction reserve (≤0%) and low myocardial blood flow reserve (<2) were independently associated with worse SAQ physical limitation and summary scores, and higher RDS.
- These associations showed a 30% to 57% increased odds for adverse outcomes (P≤0.01).
- Reversible perfusion defects and angina frequency were not significantly associated with these health status measures.
Conclusions:
- Impaired stress-induced left ventricular ejection fraction augmentation and myocardial blood flow reserve correlate with significant functional limitations and dyspnea in patients undergoing MPI.
- These findings suggest that therapies targeting systolic function and myocardial flow abnormalities may improve patient health status.
- Angina frequency was not directly associated with these specific MPI-derived hemodynamic measures.
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