Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [ 15 O] water positron emiss
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ORIGINAL ARTICLE
Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [15O] water positron emission tomography study Esa Harjulahti 1 & Teemu Maaniitty 1 & Wail Nammas 1,2 & Iida Stenström 1 & Fausto Biancari 3,4 & Jeroen J. Bax 5 & Juhani Knuuti 1 & Antti Saraste 1,2 Received: 13 July 2020 / Accepted: 26 October 2020 # The Author(s) 2020
Abstract Purpose We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [15O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD). Methods Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [15O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography. Results Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively). Conclusion In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [15O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk. Keywords Positron emission tomography . Myocardial blood flow . Chronic coronary syndromes . Net reclassification improvement
Introduction This article is part of the Topical Collection on Cardiology * Antti Saraste [email protected] 1
Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
2
Heart Center, Turku University Hospital, Turku, Finland
3
Department of Surgery, University of Turku, Turku, Finland
4
Department of Surgery, University of Oulu, Oulu, Finland
5
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Clinical practice guidelines recommend non-invasive functional imaging of myocardial ischemia for the detection of obstructive coronary artery disease (CAD) and to inform decisions on revascularization [1]. Myocardial perfusion imaging (MPI) with positron emissio
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