Reduced myocardial flow reserve (<2) was independently associated with an increased risk of incident heart failure compared to normal MFR (11.8% vs. 5.6%; adjusted HR 1.93; 95% CI 1.57-2.38).
Cohort (n=5,031)
Yes
Does reduced myocardial flow reserve (MFR < 2) predict incident heart failure in patients with suspected ischemic heart disease?
Reduced myocardial flow reserve on ⁸²Rb-PET/CT is an independent predictor of incident heart failure in patients with suspected ischemic heart disease without significant perfusion defects.
Effect estimate: HR 1.93 (95% CI 1.57-2.38)
Absolute Event Rate: 11.8% vs 5.6%
Abstract Background Heart failure (HF) is a severe condition, particularly if not treated in time, highlighting the critical importance of early diagnosis for timely intervention and improved patient outcomes. Myocardial flow reserve (MFR), a measure of coronary vasodilatory capacity assessed by ⁸²Rb-PET/CT, has been shown to predict adverse cardiovascular outcomes. However, its role in predicting HF is unclear. Purpose To assess whether reduced MFR is associated with an increased risk of incident heart failure in a Danish registry-linked cohort of patients undergoing clinically indicated ⁸²Rb-PET/CT due to suspected ischemic heart disease. Methods We included patients who underwent ⁸²Rb-PET/CT at Danish hospitals between January 2018 and August 2020. We excluded patients with left ventricular ejection fraction 45% and patients where ⁸²Rb-PET/CT indicated hemodynamic significant perfusion defects (reversible defect 10%). MFR was calculated as the ratio of myocardial blood flow during stress to rest. Patients were stratified based on MFR values (2 vs. ≥2). Patients were followed until 14th May 2024 for incident HF and pleural effusion from hospital admission. Cox proportional hazards model was used to assess the association between MFR and HF, adjusting for age and sex. Results Among 5.031 patients free of hemodynamically significant stenosis, 1.607 patients (32%) had MFR 2. Of the patients with reduced MFR, 47.9% were women, and the median age was 71.5 years, compared to 42.4% women and a median age of 65.7 years in the group with normal MFR. At baseline median LVEF was 61.5% and 60.1%, respectively, with a slight favor toward the reduced MFR group. During a median follow-up of 4.8 years, 381 (7.6%) patients were diagnosed with HF. In the unadjusted model, MFR 2 was significantly associated with increased HF risk (11.8% vs. 5.6%; HR: 2.31 95% CI: 1.89–2.82), with the association remaining significant after adjustment (HR: 1.93 95% CI: 1.57–2.38). Furthermore, reduced MFR ≤2 was significantly associated with risk of pleural effusion (1.5% vs. 0.24%; HR: 6.98 95% CI: 3.15–15.48), with the association remaining significant after adjustment (HR: 5.62 95% CI: 2.49–12.71). Conclusion Reduced MFR is independently associated with an increased risk of developing HF and pleural effusion. These findings suggest that ⁸²Rb-PET -derived MFR may serve as an early marker for HF risk stratification, and possibly contribute with guidance of early on-set treatment in patients at risk of HF.Heart Failure Pleural Effusion
Haahr et al. (Sat,) conducted a cohort in Suspected ischemic heart disease (n=5,031). Reduced myocardial flow reserve (MFR <2) vs. Normal myocardial flow reserve (MFR ≥2) was evaluated on Incident heart failure (HR 1.93, 95% CI 1.57-2.38). Reduced myocardial flow reserve (<2) was independently associated with an increased risk of incident heart failure compared to normal MFR (11.8% vs. 5.6%; adjusted HR 1.93; 95% CI 1.57-2.38).