Key result
Reduced global stress MBF links to ~2.8-fold higher MACE risk on low-dose PET/CT.
Cohort (n=234)
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Observes that stress myocardial blood flow independently predicts cardiovascular events in patients with suspected ischemia, indicating superior risk assessment with low radiation.
The most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE) has not been characterized with low-dose silicon photomultipliers (SiPM) technology, which allows halving injected activity and radiation dose delivering less than 1.0 mSv in a 70-kg individual. We prospectively enrolled 234 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT (5 MBq/kg) and were followed up for MACE over 652 days (interquartile range 559-751 days). For each participant, global stress myocardial blood flow (stress MBF), global myocardial flow reserve (MFR), and regional severely reduced myocardial flow capacity (MFCsevere) were measured. The Youden index was used to select optimal thresholds. In multivariate analysis after adjustments for clinical risk factors, reduced global stress MBF < 1.94 ml/min/g, reduced global MFR < 1.98, and regional MFCsevere > 3.2% of left ventricle emerged all as independent predictors of MACE (HR 4.5, 3.1, and 3.67, respectively, p < 0.001). However, only reduced global stress MBF remained an independent prognostic factor for MACE after adjusting for clinical risk factors and the combined use of global stress MBF, global MFR, and regional MFCsevere impairments (HR 2.81, p = 0.027). Using the latest SiPM PET technology with low-dose 82Rb halving the standard activity to deliver < 1 mSv for a 70-kg patient, impaired global stress MBF, global MFR, and regional MFC were powerful predictors of cardiovascular events, outperforming traditional cardiovascular risk factors. However, only reduced global stress MBF independently predicted MACE, being superior to global MFR and regional MFC impairments.
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Dietz et al. (2022) conducted a cohort in Suspected myocardial ischemia (n=234). Reduced global stress myocardial blood flow (<1.94 ml/min/g) on low-dose 82Rb SiPM PET/CT vs. Global myocardial flow reserve (<1.98) and regional severely reduced myocardial flow capacity (>3.2% of LV) was evaluated on Major adverse cardiovascular events (MACE) (HR 2.81, p=0.027). Reduced global stress MBF (<1.94 ml/min/g) on low-dose 82Rb SiPM PET/CT independently predicted MACE (HR 2.81, p=0.027), outperforming global MFR and regional MFC impairments.
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