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Войти в исследования Circulation. Cardiovascular imaging · 2025
Myocardial Perfusion Imaging With PET: A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference.
Сравнительное исследованиеСтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Winther Simon, Rasmussen Laust Dupont, Karim Salma Raghad, Westra Jelmer, Dahl Jonathan Nørtoft, Søby Jacob Hartmann, Nissen Louise, Lomstein Fabian Bøgild, Würtz Morten, Sundbøll Jens Munch, Ejlersen June Anita, Mortensen Jesper, Tolbod Lars Poulsen, Søndergaard Hanne Maare, Hansson Nicolaj Christopher Lyng, Nyegaard Mette, Jensen Rebekka Vibjerg, Madsen Michael Alle, Christiansen Evald Høj, Gormsen Lars Christian, Böttcher Morten
Аннотация
BACKGROUND: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (82Rb) versus [15O]H2O (15O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare 82Rb-PET versus 15O-water-PET head-to-head for diagnosing obstructive CAD.
METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements.
RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%.
CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04707859.
METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements.
RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%.
CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04707859.
Предметные рубрики MeSH
AgedFemaleHumansMaleMiddle AgedComputed Tomography AngiographyCoronary AngiographyCoronary Artery DiseaseCoronary CirculationCoronary StenosisCoronary VesselsFractional Flow Reserve, MyocardialMyocardial Perfusion ImagingOxygen RadioisotopesPositron-Emission TomographyPredictive Value of TestsRadiopharmaceuticalsRubidium RadioisotopesWater