Myocardial blood flow reserve assessed by positron emission tomography myocardial perfusion imaging identifies patients with a survival benefit from early revascularization

Patel, Krishna; Spertus, John A.; Chan, Paul S.; Sperry, Brett W.; Badarin, Firas Al; Kennedy, Kevin F.; Thompson, Randall C.; Case, James A.; McGhie, A. Iain; Bateman, Timothy M.

doi:10.1093/eurheartj/ehz389

Cited by 120 publications

(68 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…cardiac events (1, 4,5,[26][27][28]. This also relates to the optimal application of PET MPI to patients with an intermediate likelihood of having CAD.…”

mentioning

confidence: 99%

“…This enables the accurate identification and description of the extent and severity of stress-induced ischemia in individuals with suspected CAD and intermediate and high pretest probability. In addition, the concurrent assessment of regional and global hyperemic MBF and MFR enables the detection and characterization of flow-limiting effects of each single vessel in multivessel disease (2,(4)(5)(6)(7)(8)10,11,(40)(41)(42)(43)(44)(45)(46), and reductions in global MFR also convey important and incremental prognostic information in patients with and without obstructive CAD (2,3,7,14,26,39,(46)(47)(48).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Schindler¹,

Bateman²,

Berman³

et al. 2020

J Nucl Med

View full text Add to dashboard Cite

In the last decade, myocardial perfusion imaging (MPI) with PET has emerged to play a pivotal role in the clinical routine process for the detection of hemodynamically significant obstructive coronary artery disease (CAD) and cardiovascular risk stratification (1-5). The high spatial and contrast resolution in concert with photon attenuation-free images of PET have led to high image quality associated with the highest sensitivity and specificity of PET/CT perfusion imaging in the detection and characterization of CAD (1,2,6,7). In addition, the noninvasive evaluation and quantification of global and regional myocardial blood flow (MBF) in milliliters per gram per minute during hyperemic stress and at rest, as well as the calculation of the resulting myocardial flow reserve (MFR), extends the scope of standard MPI from the detection of advanced and flow-limiting epicardial CAD to a comprehensive assessment of ischemic burden. This improved scope results not only from the traditionally sought significant left main or multivessel disease, but also from the more recently appreciated cardiac effects of nonobstructive CAD and coronary microvascular disease (CMD), which conveys important diagnostic and incremental prognostic information (1,2,4-11). The increased availability and high sensitivity of PET MPI in concert with concerns about missed diagnoses, however, may at times lead to an inappropriate application of this technology. Thus, to avoid unnecessary financial burden on the health-care system and, in some cases, unnecessary exposure of patients to ionizing radiation, we have established a consensus document that outlines the most appropriate and cost-effective use of PET MPI. It is hoped that this expert guidance will help to render the use of PET MPI more consistent and will improve health-care outcomes for the targeted patient population while minimizing unnecessary imaging costs. The goal of this document is to describe the appropriate use of PET MPI in patients with suspected or known CAD and in patients with suspected microvascular angina. Through these recommendations, it is expected that PET MPI will be applied to benefit these patients in the most cost-effective manner. Representatives from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Cardiology (ACC), the American Society of Nuclear Cardiology (ASNC), the Canadian Cardiovascular Society (CCS), the Canadian Society of Cardiovascular Nuclear and CT Imaging (CSCNCTI), the Society of Cardiovascular CT (SCCT), the American Heart Association (AHA), the American College of Physicians (ACP), and the European Association of Nuclear Medicine (EANM) assembled as an autonomous workgroup to develop the following appropriate use criteria (AUC). This process was performed in accordance with the Protecting Access to Medicare Act of 2014. This legislation requires that all referring physicians consult AUC by using a clinical decision support mechanism before ordering any advanced diagnostic imaging services. Such services are de...

show abstract

“…cardiac events (1, 4,5,[26][27][28]. This also relates to the optimal application of PET MPI to patients with an intermediate likelihood of having CAD.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Schindler¹,

Bateman²,

Berman³

et al. 2020

J Nucl Med

View full text Add to dashboard Cite

show abstract

“…The independent prognostic value of absolute measures of MBF for the prediction of cardiac adverse events at long-term follow-up has been demonstrated in several studies [14][15][16][17][18][19][20][21][26][27][28]. However, there is a significant heterogeneity in studies in terms of risk estimates, patient populations, and measures of MBF [14].…”

Section: Discussionmentioning

confidence: 99%

Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [15O] water positron emission tomography study

Harjulahti

Maaniitty

Nammas

et al. 2020

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [15O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD). Methods Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [15O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography. Results Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively). Conclusion In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [15O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.

show abstract

“…7 Beyond prognostic risk stratification, initial retrospective work suggests that patients with a low MFR may benefit from early revascularization. 8,9 Moreover, among obese patients, MFR may identify higher-risk patients more likely to benefit from bariatric surgery than lower-risk patients. 10 In aggregate, impaired MFR, particularly absent severely obstructive CAD, is of recognized clinical value and may represent a novel target for cardiovascular disease risk reduction.…”

Section: See Related Article Pp 1104-1113mentioning

confidence: 99%