Circulation. Cardiovascular imaging · 2025
Prognostic Utility of Quantitative Perfusion PET in Patients With Prior CABG: Incremental Value of Myocardial Flow Reserve and Coronary Vascular Resistance.
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Kadoya Yoshito, Da Silva Edgar, AlTakroni Lulwa A, Hejji Nuha, Boczar Kevin E, Chow Benjamin J W, deKemp Robert A, Ruddy Terrence D, Beanlands Rob S, Small Gary R
Аннотация
BACKGROUND: The prognostic utility of quantitative positron emission tomography (PET) with myocardial blood flow (MBF) measurements in patients with prior coronary artery bypass grafting remains unestablished. We evaluated PET-derived myocardial flow reserve (MFR) and coronary vascular resistance (CVR) for risk stratification in patients who have undergone coronary artery pass grafting.
METHODS: This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR and CVR were defined as the ratio of stress to rest myocardial blood flow and mean arterial pressure divided by stress myocardial blood flow, respectively. The primary end point was major adverse cardiovascular events (MACE), defined as a composite of cardiac mortality and nonfatal myocardial infarction. The secondary end point (expanded MACE) included MACE plus hospitalization for unstable angina or heart failure. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters.
RESULTS: A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482-1077) days, 39 patients (7.0%) experienced MACE, and 74 (13.3%) experienced expanded MACE. Receiver operating characteristic analysis identified optimal cutoff values of 2.05 for MFR and 66.4 mm Hg·min·g/mL for CVR. Impaired MFR and CVR were each significantly associated with increased rates of MACE and expanded MACE (all P<0.001). Stratification by combined MFR and CVR status demonstrated significant differences in event rates across groups (all P<0.001). In multivariable analysis, MFR (≤2.05), CVR (≥66.4 mm Hg·min·g/mL), and their combination were all independently associated with MACE, with adjusted hazard ratio of 2.954 ([95% CI, 1.287-6.780]; P=0.011), 2.356 ([95% CI, 1.075-5.161]; P=0.032), and 5.437 ([95% CI, 2.700-10.950]: P<0.001), respectively.
CONCLUSIONS: PET-derived MFR and CVR provide independent and incremental prognostic value in coronary artery bypass grafting patients, enhancing risk stratification beyond conventional perfusion and function parameters.
METHODS: This retrospective study included consecutive patients undergoing Rubidium-82 PET myocardial perfusion imaging between May 2017 and November 2023. MFR and CVR were defined as the ratio of stress to rest myocardial blood flow and mean arterial pressure divided by stress myocardial blood flow, respectively. The primary end point was major adverse cardiovascular events (MACE), defined as a composite of cardiac mortality and nonfatal myocardial infarction. The secondary end point (expanded MACE) included MACE plus hospitalization for unstable angina or heart failure. Associations were assessed using multivariable Cox proportional hazards models after adjusting for clinical variables and PET parameters.
RESULTS: A total of 556 patients (median age 72 years, 79% male) were included. Over a median follow-up of 676 (482-1077) days, 39 patients (7.0%) experienced MACE, and 74 (13.3%) experienced expanded MACE. Receiver operating characteristic analysis identified optimal cutoff values of 2.05 for MFR and 66.4 mm Hg·min·g/mL for CVR. Impaired MFR and CVR were each significantly associated with increased rates of MACE and expanded MACE (all P<0.001). Stratification by combined MFR and CVR status demonstrated significant differences in event rates across groups (all P<0.001). In multivariable analysis, MFR (≤2.05), CVR (≥66.4 mm Hg·min·g/mL), and their combination were all independently associated with MACE, with adjusted hazard ratio of 2.954 ([95% CI, 1.287-6.780]; P=0.011), 2.356 ([95% CI, 1.075-5.161]; P=0.032), and 5.437 ([95% CI, 2.700-10.950]: P<0.001), respectively.
CONCLUSIONS: PET-derived MFR and CVR provide independent and incremental prognostic value in coronary artery bypass grafting patients, enhancing risk stratification beyond conventional perfusion and function parameters.