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Prognostic value of transient ischemic dilation on Rubidium-82 positron emission tomography myocardial perfusion
Krishna K Patel1, Phillip Lim2, Poghni A Peri-Okonny3
1Department of Medicine (Cardiology), Mount Sinai Fuster Hear Hospital, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Transient ischemic dilation (TID) on rubidium-82 (82Rb) PET MPI is a significant predictor of cardiac death in patients with preserved left ventricular ejection fraction (LVEF ≥40%). This risk marker is valuable regardless of whether myocardial perfusion is normal or abnormal.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Transient ischemic dilation (TID) of the left ventricle (LV) is a high-risk indicator in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
- Rubidium-82 (82Rb) PET MPI allows for stress image acquisition at peak stress, unlike SPECT's delayed acquisition.
Purpose of the Study:
- To determine the prognostic significance of TID in patients undergoing 82Rb PET MPI.
- To assess if TID predicts cardiac death independently of other established risk factors.
Main Methods:
- Analysis of 9878 patients with LVEF ≥40% who underwent rest/stress 82Rb PET MPI between 2010 and 2016.
- Median follow-up of 3.2 years for cardiac death, adjusting for clinical risk factors, LVEF, LVEF reserve (LVEF-R), myocardial blood flow reserve (MBFR), and revascularization.
- Investigated interactions between TID and summed stress score (SSS) to evaluate TID's prognostic value across different perfusion statuses.
Main Results:
- Higher TID ratios correlated with an increased risk of cardiac death (HR per 0.1 unit increase = 1.25; P < .001), even after adjusting for LVEF-R and MBFR.
- This association persisted in patients with normal perfusion (HR = 1.24; P = .04) and abnormal perfusion (HR = 1.14; P = .03).
Conclusions:
- Transient ischemic dilation (TID) on 82Rb PET MPI provides independent prognostic information.
- TID is a valuable risk marker for cardiac death in patients with LVEF ≥40%, irrespective of their myocardial perfusion status.
Background:
Transient ischemic dilation (TID) of the left ventricular (LV) cavity is considered a high-risk marker in patients with abnormal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Stress image acquisition with rubidium-82 (82Rb) PET occurs at peak stress compared to 30-60 minutes post-stress with SPECT. We aimed to evaluate the prognostic value of TID in patients undergoing 82Rb PET MPI.
Methods:
A total of 9878 consecutive patients with LVEF ≥40% undergoing rest/pharmacologic stress 82Rb PET MPI from 2010 to 2016 were followed for a median of 3.2 years. The primary clinical outcome of cardiac death was assessed after adjusting for pre-test risk, known coronary artery disease (CAD), resting left ventricular ejection fraction (LVEF), summed stress score (SSS), LVEF reserve (LVEF-R), myocardial blood flow reserve (MBFR), and early (90-day) revascularization. Pre-specified interactions between TID and SSS were included to assess potential differences in the prognostic value of TID in patients based on perfusion.
Results:
The mean age of the cohort was 69.0 (11.7) years with 56.1% being female, 49.8% having known CAD, and 27.9% having abnormal perfusion (SSS>0). There were 451 cardiac deaths. Higher TID ratios were associated with higher risk of cardiac death, even after accounting for LVEF-R and MBFR (HR per .1 unit increase = 1.25 (1.11, 1.41), P < .001). This was seen in patients with both normal (HR for TID per .1 unit increase = 1.24 (95% CI: 1.01, 1.52), P = .04) and abnormal perfusion (HR for TID per .1 unit increase = 1.14 (95% CI: 1.02, 1.28), P = .03).
Conclusions:
TID on rest/stress 82Rb PET MPI offers independent prognostic value in patients with both normal and abnormal perfusion independent of other risk factors in patients with LVEF ≥40%.
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