title: Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging.
abstract: OBJECTIVE
  We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with (82)Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia.
  
  
  RESULTS
  Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan-Meier method in 318 patients after excluding 17 patients with early revascularizations (<60 days). Independent predictors of MACEs were identified by multivariate analysis. During a median follow-up of 624 days (inter-quartile range 540-697), 35 MACEs occurred. An annualized MACE rate was higher in patients with ischaemia (SDS >2) (n = 105) than those without [14% (95% CI = 9.1-22%) vs. 4.5% (2.7-7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11-25%) vs. 2.9% (1.2-7.0%) and 4.3% (2.1-9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2-22%) vs. 7.3% (4.2-13%) and 1.8% (0.6-5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia.
  
  
  CONCLUSIONS
  Perfusion findings in (82)Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.
authors: Nuclear Medicine Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland.
authors: Hoshang
authors: H
authors: Farhad
authors: Vincent
authors: V
authors: Dunet
authors: Kim
authors: K
authors: Bachelard
authors: Gilles
authors: G
authors: Allenbach
authors: Philipp A
authors: PA
authors: Kaufmann
authors: John O
authors: JO
authors: Prior
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003326:Coronary Circulation / Q000502:physiology; D018450:Disease Progression; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007089:Image Enhancement; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012414:Rubidium Radioisotopes; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D012414:Rubidium Radioisotopes
keywords: Coronary artery disease; Major adverse cardiovascular events; Myocardial perfusion imaging; Outcome; Positron emission tomography; Rubidium-82