Abstract
Background
Myocardial flow reserve (MFR) and the extent of myocardial ischemia identify patients at high risk of major adverse cardiovascular events (MACEs). Associations between positron emission tomography (PET)-assessed extent of ischemia, MFR, and MACEs is unclear.
Method
Overall, 640 consecutive patients with suspected or known coronary artery disease undergoing 13N-ammonia myocardial perfusion PET were followed-up for MACEs. Patients were categorized into three groups based on myocardial ischemia severity: Group I (n = 335), minimal (myocardial ischemia < 5%); Group II (n = 150), mild (5–10%); and Group III (n = 155), moderate-to-severe (> 10%).
Results
Cardiovascular death and MACEs occurred in 17 (3%) and 93 (15%) patients, respectively. Following statistical adjustment for confounding factors, impaired MFR (global MFR < 2.0) was revealed as an independent predictor of MACEs in Groups I (hazard ratio [HR], 2.89; 95% confidence interval [CI], 1.48–5.64; P = 0.002) and II (HR, 3.40; 95% CI 1.37–8.41; P = 0.008) but was not significant in Group III (HR, 1.15; 95% CI 0.59–2.26; P = 0.67), with a significant interaction (P < 0.0001) between the extent of myocardial ischemia and MFR.
Conclusion
Impaired MFR was significantly associated with increased risk of MACEs in patients with ≤ 10% myocardial ischemia but not with those having > 10% ischemia, allowing a clinically effective risk stratification.
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Discover the latest articles, news and stories from top researchers in related subjects.Abbreviations
- CAD:
-
Coronary artery disease
- HF:
-
Heart failure
- MACE:
-
Major adverse cardiac event
- MBF:
-
Myocardial blood flow
- MFR:
-
Myocardial flow reserve
- MPI:
-
Myocardial perfusion imaging
- PCI:
-
Percutaneous coronary intervention
- PET:
-
Positron emission tomography
- SDS:
-
Summed difference score
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Miura, S., Okizaki, A., Kumamaru, H. et al. Interaction of impaired myocardial flow reserve and extent of myocardial ischemia assessed using 13N-ammonia positron emission tomography imaging on adverse cardiovascular outcomes. J. Nucl. Cardiol. 30, 2043–2053 (2023). https://doi.org/10.1007/s12350-023-03255-x
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DOI: https://doi.org/10.1007/s12350-023-03255-x