European heart journal. Cardiovascular Imaging · 2026
Impact of rate-pressure product correction of myocardial blood flow on the prognostic relevance in patients with heart failure.
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Anderton Thomas, Chambers Bradley, Farooq Maryum, Soo Chin Yit, Asad Mehak, Gibbs Michelle, Harrison Peter, Tariq Osama, Javed Wasim, Dall'Armellina Erica, Kellman Peter, Plein Sven, Swoboda Peter P, Takafuji Masafumi
Аннотация
AIMS: Quantitative perfusion cardiac magnetic resonance (QP-CMR) allows estimation of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR). Resting MBF values are often corrected for the rate-pressure product (RPP). We aimed to assess the effect of RPP correction on MBF values and the prognostic value of QP-CMR in patients with heart failure (HF).
METHODS AND RESULTS: QP-CMR data from 641 prospectively recruited patients with HF and 184 healthy volunteers were analysed. Rest MBF was corrected for RPP (MBFcorr = rest MBFuncorr×10 000/RPP). Corrected MPR was defined as uncorrected stress MBF/rest MBFcorr. The primary endpoint was a composite of heart failure hospitalization (HFH) and all-cause mortality. RPP correction increased rest MBF and decreased MPR to a greater extent in healthy volunteers than in patients. During median follow-up of 3.5 years, 101 events occurred (55 deaths and 46 HFH). Patients who reached the primary endpoint had significantly higher rest MBFuncorr and lower MPRuncorr. Rest MBFuncorr (adjusted hazard ratio per 1 mL/g/min increase, 3.97, 95% confidence interval [CI] 1.93-8.16, P < 0.001) and MPRuncorr (adjusted hazard ratio per 1-unit increase, 0.74, 95% CI 0.57-0.95, P = 0.024) were significantly associated with the primary endpoint in univariate and multivariate models. After RPP correction, these associations were no longer significant. Kaplan-Meier analysis revealed significant differences in event-free survival for rest MBFuncorr (P = 0.005), MPRuncorr (P < 0.001), and MPRcorr (P = 0.044), but not for rest MBFcorr (P = 0.076).
CONCLUSION: Uncorrected rest MBF and MPR by QP-CMR are independently predictive of adverse outcomes in patients with HF. RPP correction changes MBF and MPR values and attenuates their predictive value.
METHODS AND RESULTS: QP-CMR data from 641 prospectively recruited patients with HF and 184 healthy volunteers were analysed. Rest MBF was corrected for RPP (MBFcorr = rest MBFuncorr×10 000/RPP). Corrected MPR was defined as uncorrected stress MBF/rest MBFcorr. The primary endpoint was a composite of heart failure hospitalization (HFH) and all-cause mortality. RPP correction increased rest MBF and decreased MPR to a greater extent in healthy volunteers than in patients. During median follow-up of 3.5 years, 101 events occurred (55 deaths and 46 HFH). Patients who reached the primary endpoint had significantly higher rest MBFuncorr and lower MPRuncorr. Rest MBFuncorr (adjusted hazard ratio per 1 mL/g/min increase, 3.97, 95% confidence interval [CI] 1.93-8.16, P < 0.001) and MPRuncorr (adjusted hazard ratio per 1-unit increase, 0.74, 95% CI 0.57-0.95, P = 0.024) were significantly associated with the primary endpoint in univariate and multivariate models. After RPP correction, these associations were no longer significant. Kaplan-Meier analysis revealed significant differences in event-free survival for rest MBFuncorr (P = 0.005), MPRuncorr (P < 0.001), and MPRcorr (P = 0.044), but not for rest MBFcorr (P = 0.076).
CONCLUSION: Uncorrected rest MBF and MPR by QP-CMR are independently predictive of adverse outcomes in patients with HF. RPP correction changes MBF and MPR values and attenuates their predictive value.