Key result
In diabetic patients with suspected coronary artery disease and normal myocardial perfusion, reduced myocardial flow reserve was associated with a significantly higher annualized cardiac event rate compared to preserved flow reserve (3.3% vs 0.4%).
Why the study?
The authors sought to assess the prognostic value of structural abnormalities and coronary vasodilator function in diabetic patients referred for PET/CT for suspected CAD.
Does reduced myocardial flow reserve predict cardiac events in diabetic patients with suspected CAD and normal myocardial perfusion imaging?
Cohort (n=902)
No
Does reduced myocardial flow reserve predict cardiac events in diabetic patients with suspected CAD and normal myocardial perfusion imaging?
Absolute Event Rate: 3.3% vs 0.4%
p-value: p=<0.001
Reduced myocardial flow reserve identifies a high-risk subset of diabetic patients for future cardiac events, even when standard myocardial perfusion imaging is normal.
Reduced MFR identifies higher event risk in diabetics with normal perfusion; hypothesis-generating for risk stratification.
BACKGROUND: We assessed the prognostic value of structural abnormalities and coronary vasodilator function in diabetic patients referred to a PET/CT for suspected coronary artery disease (CAD). METHODS: We studied 451 diabetics and 451 nondiabetics without overt CAD and normal myocardial perfusion. Myocardial blood flow (MBF) was computed from the dynamic rest and stress imaging. Myocardial flow reserve (MFR) was defined as ratio of hyperemic to baseline MBF and was considered reduced when < 2. RESULTS: During a mean follow-up of 44 months 33 events occurred. Annualized event rate (AER) was higher in diabetic than nondiabetic patients (1.4% vs 0.3%, P < .001). Diabetic patients with reduced MFR had higher AER compared to those with preserved MFR (3.3% vs 0.4%, P < .001). At Cox analysis, age, BMI and reduced MFR were independent predictors of events in diabetic patients. Patients with diabetes and reduced MFR had lower event-free survival compared to nondiabetic patients and MFR < 2 (P < .001). Event-free survival was similar in patients with diabetes and normal MFR and those without diabetes and reduced MFR. CONCLUSIONS: Diabetic patients with reduced MFR had higher AER and lower event-free survival compared to those with preserved MFR and to nondiabetic patients.
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Assante et al. (2021) conducted a cohort in Suspected coronary artery disease with normal myocardial perfusion imaging (n=902). Reduced myocardial flow reserve (MFR < 2) vs. Preserved myocardial flow reserve (MFR ≥ 2) was evaluated on Annualized event rate of cardiac death, nonfatal myocardial infarction, or unstable angina requiring coronary revascularization (p=<0.001). In diabetic patients with suspected coronary artery disease and normal myocardial perfusion, reduced myocardial flow reserve was associated with a significantly higher annualized cardiac event rate compared to preserved flow reserve (3.3% vs 0.4%).
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