Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2025
Beyond flow reserve: Comparative prognostic value of myocardial blood flow reserve, peak stress myocardial blood flow, and blood flow reserve corrected for resting rate pressure product in patients undergoing positron emission tomography myocardial perfusion imaging.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Khan Mirza S, Bateman Timothy M, Case James A, Sperry Brett W
Аннотация
BACKGROUND: Global myocardial blood flow reserve (MBFR) demonstrates diagnostic and prognostic value beyond visual perfusion defect assessment. However, high resting rate-pressure product (RPP) can influence MBFR interpretation. Data are mixed regarding the importance of further stratifying MBFR by peak stress MBF or RPP-corrected MBFR (cMBFR) values.
METHODS: This retrospective study consisted of consecutive patients referred for positron emission tomography myocardial perfusion imaging (PET MPI) at Saint Luke's Health System (2010-2016). Patients were categorized based on impaired or preserved levels of MBFR (<2 vs ≥ 2), cMBFR (<2 vs ≥ 2), and peak stress MBF (<1.7 vs ≥ 1.7 mL/min/g). All-cause mortality across groups was assessed using Kaplan-Meier and log-rank tests, with goodness-of-fit assessed using likelihood ratio tests.
RESULTS: Of 13,632 consecutive patients referred for PET MPI, the median age was 70 (IQR: 61-77) years, 50.2 % were female, and the median follow-up was 8.3 years. Over the study period, 30.6 % of patients died; 73.5 % of whom had MBFR<2. Preserved MBFR was associated with the most favorable prognosis, regardless of cMBFR or peak stress MBF. Those with MBFR <2 and impairment of either peak stress MBF or cMBFR had the poorest prognosis. In those with MBFR<2, normal peak stress MBF identified a group with intermediate prognosis slightly better than the presence of preserved cMBFR (P = .012 vs .064, respectively).
CONCLUSIONS: In this large cohort, normal MBFR predicted favorable outcomes independent of cMBFR or peak stress MBF. Inclusion of peak stress MBF beyond MBFR and traditional risk factors improved model fit compared to cMBFR and helped to risk stratify patients with impaired MBFR.
METHODS: This retrospective study consisted of consecutive patients referred for positron emission tomography myocardial perfusion imaging (PET MPI) at Saint Luke's Health System (2010-2016). Patients were categorized based on impaired or preserved levels of MBFR (<2 vs ≥ 2), cMBFR (<2 vs ≥ 2), and peak stress MBF (<1.7 vs ≥ 1.7 mL/min/g). All-cause mortality across groups was assessed using Kaplan-Meier and log-rank tests, with goodness-of-fit assessed using likelihood ratio tests.
RESULTS: Of 13,632 consecutive patients referred for PET MPI, the median age was 70 (IQR: 61-77) years, 50.2 % were female, and the median follow-up was 8.3 years. Over the study period, 30.6 % of patients died; 73.5 % of whom had MBFR<2. Preserved MBFR was associated with the most favorable prognosis, regardless of cMBFR or peak stress MBF. Those with MBFR <2 and impairment of either peak stress MBF or cMBFR had the poorest prognosis. In those with MBFR<2, normal peak stress MBF identified a group with intermediate prognosis slightly better than the presence of preserved cMBFR (P = .012 vs .064, respectively).
CONCLUSIONS: In this large cohort, normal MBFR predicted favorable outcomes independent of cMBFR or peak stress MBF. Inclusion of peak stress MBF beyond MBFR and traditional risk factors improved model fit compared to cMBFR and helped to risk stratify patients with impaired MBFR.