Incremental Prognostic Value of Subendocardial Myocardial Flow Reserve in Patients With Normal Perfusion.
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Lopez Diana M, Brown Jenifer M, Divakaran Sanjay, Huck Daniel M, Weber Brittany N, Hainer Jon, Carre Sylvain, Lemley Mark, Ramirez Giselle, Shanbhag Aakash, Kavanagh Paul, Liang Joanna X, Blankstein Ron, Dorbala Sharmila, Dey Damini, Knight Stacey, Le Viet T, Mason Steve, Wopperer Samuel, Chareonthaitawee Panithaya, Rosamond Thomas L, Kwiecinski Jacek, Miller Robert J H, Slipczuk Leandro, Travin Mark I, Alexanderson Erick, Carvajal-Juarez Isabel, Packard René R S, Al-Mallah Mouaz H, Einstein Andrew J, Feher Attila, Acampa Wanda, Sanghani Rupa, Buechel Ronny R, deKemp Robert A, Berman Daniel S, Slomka Piotr J, Di Carli Marcelo F
Аннотация
METHODS: We studied patients in a multicenter PET registry with normal perfusion on stress/rest Rb-82 PET, excluding those with a previous history of coronary artery bypass surgery, heart transplantation, or left ventricular ejection fraction <40%. The optimal MFRSE cutoff for predicting major adverse cardiovascular events (MACEs; death, myocardial infarction [MI], revascularization, or heart failure [HF] hospitalization) was determined using Youden's index. Patients were stratified into 3 groups: concordant-normal (MFRTM ≥2.0; MFRSE ≥2.1), discordant (low-MFRSE, normal MFRTM), and abnormal MFRTM. Clinical outcomes were compared by MFR groups.
RESULTS: Among 6603 patients (normal N=4103; discordant N=885; abnormal N=1615) the mean age was 66.3±12.4 years, and 54% were women. Compared with the concordant-normal group, patients with discordant low-MFRSE were older and more likely to have hypertension, diabetes, peripheral artery disease, and previous percutaneous coronary intervention. The median MFRTM for normal, discordant, and abnormal groups were 2.86, 2.15, and 1.72, respectively. Over a median follow-up of 4.9 years, 1661 MACE events occurred. Discordant low-MFRSE patients had a higher risk of MACE (hazard ratio [HR], 1.41; 95% CI, 1.22-1.64) and all-cause mortality (HR, 1.36; 95% CI, 1.14-1.61) compared with concordant-normal patients. The discordant group had an intermediate absolute risk of MACE, with an adjusted annualized event rate of 5.79% (95% CI, 5.10-6.49) compared with 3.99% (95% CI, 3.67-4.30; P<0.001) in the concordant-normal group and 8.35% (95% CI, 7.71-9.00; P<0.001) in the abnormal MFRTM group.
CONCLUSIONS: Subendocardial MFR reveals clinically meaningful risk heterogeneity among patients with preserved transmural flow reserve, helping refine risk stratification beyond traditional PET metrics.