Key result
Low left ventricular ejection fraction reserve and low myocardial blood flow reserve on PET MPI were associated with worse physical limitation, health status, and dyspnea (30-57% greater odds; P≤0.01).
Why the study?
Myocardial perfusion imaging identifies abnormalities early in the ischemic cascade, but its association with patients' health status, symptoms, function, and quality of life needed evaluation.
Cross-Sectional (n=1,515)
Effect estimate: 30% to 57% greater odds
p-value: p=≤0.01
Impaired augmentation of left ventricular ejection fraction and myocardial blood flow during stress PET MPI correlates with worse functional limitation and dyspnea, but not angina frequency, in patients with known or suspected CAD.
Should not yet change practice in CAD; leaves open whether LVEF and MBFR reserve improve symptom risk stratification.
Background: Myocardial perfusion imaging (MPI) identifies abnormalities that occur early in the ischemic cascade leading to angina. Our aim was to study the association between ischemic measures on positron emission tomography MPI and patients’ health status; their symptoms, function, and quality of life. Methods: Health status was collected using the Seattle Angina Questionnaire (SAQ-7, 0–100, higher=better) and Rose Dyspnea Score (RDS) on 1515 outpatients with known or suspected coronary artery disease presenting for clinically indicated pharmacological 82 Rb positron emission tomography MPI from July 2018 to July 2019. Adjusted multivariable ordinal regression models were used to assess the association between MPI findings of ischemia and the SAQ physical limitation, angina frequency, quality of life, summary score, and the RDS. Results: The mean SAQ and RDS scores of the cohort (mean age 71.7 years, 55% male, 37.6% prior myocardial infarction or revascularization) were 73.8±28.6 (physical limitation), 87.4±21.7 (angina frequency), 79.0±26.1 (quality of life), 81.3±19.0 (summary score), and 2±2 (RDS). No perfusion, flow or function abnormalities were significantly associated with SAQ angina frequency scores. Low left ventricular ejection fraction reserve (≤0%), low global and regional myocardial blood flow reserve (<2) were independently associated with worse SAQ Physical Limitation score, SAQ summary score, and RDS (30% to 57% greater odds; all P ≤0.01), but reversible perfusion defects were not. Conclusions: Impaired augmentation of left ventricular ejection fraction and myocardial blood flow with stress is associated with significant angina-associated functional limitation, health status, and dyspnea in patients who underwent positron emission tomography MPI, but not the frequency of their angina. Future studies should evaluate whether therapies that improve stress-induced abnormalities in systolic function and myocardial flow may improve patients’ health status.
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A 2022 study conducted a cross-sectional in known or suspected coronary artery disease (n=1,515). Low left ventricular ejection fraction reserve and low myocardial blood flow reserve vs. Normal reserve was evaluated on SAQ physical limitation, angina frequency, quality of life, summary score, and Rose Dyspnea Score (30% to 57% greater odds, p=≤0.01). Low left ventricular ejection fraction reserve and low myocardial blood flow reserve on PET MPI were associated with worse physical limitation, health status, and dyspnea (30-57% greater odds; P≤0.01).
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