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Prognostic Value of Modified Coronary Flow Capacity Derived From [15O]H2O Positron Emission Tomography Perfusion
Ruben W de Winter1, Ruurt A Jukema1, Pepijn A van Diemen1
1Departments of Cardiology (R.W.d.W., R.A.J., P.A.v.D., S.P.S., Y.B.O.S., T.P.v.d.H., A.C.v.R., A.N., I.D., P.K.), Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, the Netherlands.
Insights
Coronary flow capacity (CFC) measured by [15O]H2O PET imaging predicts adverse outcomes in patients with coronary artery disease. Reduced CFC, particularly severe reductions and myocardial steal, is linked to a higher risk of death and myocardial infarction.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Coronary flow capacity (CFC) quantifies coronary artery disease impact on vasodilator function.
- Modified CFC integrates hyperemic myocardial blood flow and coronary flow reserve.
- This study investigates the prognostic value of modified CFC using [15O]H2O PET.
Purpose of the Study:
- To evaluate the prognostic significance of modified coronary flow capacity (CFC) derived from [15O]H2O PET imaging.
- To assess the association between different levels of CFC and cardiovascular outcomes.
- To determine if modified CFC provides independent prognostic information beyond traditional perfusion metrics.
Main Methods:
- Quantitative rest/stress [15O]H2O PET perfusion imaging in 1300 patients.
- Classification of patients into groups based on CFC thresholds: myocardial steal, severely, moderately, minimally reduced CFC, and normal flow.
- Follow-up for a composite endpoint of death and nonfatal myocardial infarction.
Main Results:
- Myocardial steal, severely reduced CFC, and moderately reduced CFC were associated with significantly worse prognosis.
- Increased resting myocardial blood flow, decreased hyperemic myocardial blood flow, and decreased coronary flow reserve independently predicted adverse outcomes.
- Modified CFC demonstrated independent prognostic value after adjusting for clinical factors and other perfusion metrics.
Conclusions:
- [15O]H2O PET-derived myocardial blood flow, coronary flow reserve, and CFC are prognostic indicators for adverse cardiovascular events.
- Modified CFC independently predicts adverse outcomes in patients with known or suspected coronary artery disease.
- Modified CFC offers valuable prognostic information in cardiovascular risk stratification.
Background:
Coronary flow capacity (CFC) is a measure that integrates hyperemic myocardial blood flow and coronary flow reserve to quantify the pathophysiological impact of coronary artery disease on vasodilator capacity. This study explores the prognostic value of modified CFC derived from [15O]H2O positron emission tomography perfusion imaging.
Methods:
Quantitative rest/stress perfusion measurements were obtained from 1300 patients with known or suspected coronary artery disease. Patients were classified as having myocardial steal (n=38), severely reduced CFC (n=141), moderately reduced CFC (n=394), minimally reduced CFC (n=245), or normal flow (n=482) using previously defined thresholds. The end point was a composite of death and nonfatal myocardial infarction.
Results:
During a median follow-up of 5.5 (interquartile range, 3.7-7.8) years, the end point occurred in 153 (12%) patients. Myocardial steal (hazard ratio [HR], 6.70 [95% CI, 3.21-13.99]; P<0.001), severely reduced CFC (HR, 2.35 [95% CI, 1.16-4.78]; P=0.018), and moderately reduced CFC (HR, 1.95 [95% CI, 1.11-3.41]; P=0.020) were associated with worse prognosis compared with normal flow, after adjusting for clinical characteristics. Similarly, in the overall population, increased resting myocardial blood flow (HR, 3.05 [95% CI, 1.68-5.54]; P<0.001), decreased hyperemic myocardial blood flow (HR, 0.68 [95% CI, 0.52-0.90]; P=0.007) and decreased coronary flow reserve (HR, 0.55 [95% CI, 0.42-0.71]; P<0.001) were independently associated with adverse outcome. In a model adjusted for the combined use of perfusion metrics, modified CFC demonstrated independent prognostic value (overall P=0.017).
Conclusions:
[15O]H2O positron emission tomography-derived resting myocardial blood flow, hyperemic myocardial blood flow, coronary flow reserve, and CFC are prognostic factors for death and nonfatal myocardial infarction in patients with known or suspected coronary artery disease. Importantly, after adjustment for clinical characteristics and the combined use of [15O]H2O positron emission tomography perfusion metrics, modified CFC remained independently associated with adverse outcome.
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