scholarly journals Survival Outcome with Routine Clinical Use of 82Rb PET/CT Myocardial Blood Flow (MBF) Quantification

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
S Wan ◽  
ME Speechly-Dick ◽  
LJ Menezes ◽  
R Endozo ◽  
R Bell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Blood Flow ◽  
Ejection Fraction ◽  
Myocardial Blood Flow ◽  
Univariate Analysis ◽  
Myocardial Flow Reserve ◽  
Flow Reserve ◽  
Pet Ct ◽  
Myocardial Flow

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): NIHR Biomedical Research Centre, University College London Hospitals Background The prognostic value of 82Rb PET/CT derived myocardial blood flow (MBF) is increasingly recognised in both general and specific cardiovascular populations. Purpose This study investigates the prognostic potential of MBF in a large cohort of patients undergoing routine 82Rb PET/CT examination. Methods 1148 consecutive patients (687 males, mean age 64 +/- 12 years) whom had been referred for 82Rb PET/CT examination in a single centre were included in this study.  All patients completed a stress 82Rb PET/CT with adenosine infusion, paired with a rest study.  Dynamic PET acquisitions were performed in both. Cardiovascular risk factors were documented as per clinical routine. Images were checked for quality and analysed using a proprietary software by an experienced operator to derive MBF parameters.  Overall survival was recorded following the study. Results Median follow-up period was 71 +/- 28 months.  Mean survival was 121 (95% CI: 118-124) months. On univariate analysis, global myocardial flow reserve <1.77 was associated with a higher all-cause mortality (p < 0.001). Other parameters including higher age (> =76 years), lower BMI (<21), qualitative abnormality on the myocardial perfusion scan (MPS), low hyperaemic ejection fraction on the gated studies (stress < 37 and rest < 34). Patients being on cardiac glycosides and diuretics were also significant predictor of poor prognosis (p < 0.001) on univariate analysis, presumably reflecting underlying arrhythmia and heart failure. A multivariate Cox regression analysis (step-wise Forward Wald), comprising of the above significant univariate markers, highlighted global myocardial flow reserve (HR: 2.6, 95%CI: 1.8-3.6, p < 0.001), age (HR: 2.8, 95%CI: 2.0-3.9, p < 0.001),, BMI (HR: 2.7, 95%CI: 1.7-4.1, p < 0.001),, ejection fraction (stress - HR: 3.3, 95%CI: 2.3-4.8, p < 0.001), MPS (HR: 1.5, 95%CI: 1.1-2.1, p = 0.024), and patients on diuretics (HR: 1.8, 95%CI: 1.2-2.5, p = 0.003) were independent predictors of overall survival (overall model: p < 0.001) Discussion We show that high volume routinely derived MBF in patients undergoing 82Rb PET/CT is a strong predictor of mortality and independent of other risk factors. This has important clinical implication for measuring not only interventional treatment but also measuring the effect of lifestyle and medical strategies.

scholarly journals Comparison of the Prognostic Value of Global and Regional Myocardial Flow Capacity Radius, Myocardial Flow Reserve, and Stress Myocardial Blood Flow Using Rubidium-82 with SiPM PET/CT

2021 ◽  
Author(s):  
Matthieu DIETZ ◽  
Christel H Kamani ◽  
Gilles Allenbach ◽  
Vladimir Rubimbura ◽  
Stephane Fournier ◽  
...  
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Myocardial Flow Reserve ◽  
Flow Capacity ◽  
Flow Reserve ◽  
Stress Myocardial Blood Flow ◽  
Pet Ct ◽  
Myocardial Flow ◽  
Rubidium 82 ◽  
Regional Myocardial Flow

Abstract Purpose The aim of this study was to assess the most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE), on the latest PET camera using silicon photomultipliers digital readout (SiPM) technology. Methods We prospectively enrolled 274 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT and were followed-up for MACE over 652 days (interquartile range: 559 to 751 days). For each participant, global and regional myocardial flow reserve (MFR), stress myocardial blood flow (stress MBF) and their combination as myocardial flow capacity radius (MFC radius) were measured. Results On receiver operator curve analysis, MACE prediction was similar for global and regional MFR, stress MBF, and MFC radius (area under the curve; (i) Global: 0.70 vs. 0.71 and 0.73, and (ii) Regional: 0.71 vs. 0.71 and 0.73, respectively, p > 0.1 for all pairwise comparisons). On multivariable analysis, (i) Global: MFR < 1.98, stress MBF < 1.94 mL/g/min, and MFC radius < 3.12, as well as (ii) Regional: MFR < 1.75, stress MBF < 1.75 mL/g/min, and MFC radius < 2.7, emerged all as similar independent predictors of MACE (p < 0.001 for all). Conclusions Using the latest SiPM PET technology with 82Rb, global and regional MFR, stress MBF, and MFC radius are similar powerful predictors of cardiovascular event.

scholarly journals Discordance between invasive coronary flow reserve (CFR) and non-invasive myocardial flow reserve (MFR) in diffuse coronary ectasia (DCE)

2020 ◽  
Vol 6 (2) ◽  
pp. 20190046
Author(s):  
Mohammed Khalil ◽  
Deniz Alibazoglu ◽  
Cem Numan Balci ◽  
Rawan Hussein ◽  
Abraham Abuwadi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Myocardial Blood Flow ◽  
Suspected Coronary Artery Disease ◽  
Myocardial Flow Reserve ◽  
Total Occlusion ◽  
Flow Reserve ◽  
Stress Myocardial Blood Flow ◽  
Coronary Ectasia ◽  
Myocardial Flow

Clinical use with evidence base for diagnostic and prognostic value of quantitative positron emission tomography(PET) myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease has exponentially increased over the last decade. This case illustrates the very first time that stress myocardial blood flow(MBF) in absolute terms (ml/min/gram) and myocardial flow reserve(MFR) are augmented in three vessel diffuse coronary ectasia by N13-Ammonia PET MPI. Moreover, relative qualitative MPI demonstrated moderate-sized ischemia in right coronary artery territory with chronic total occlusion in middle segment; despite regional myocardial flow reserve remains above ischemic thresholds while regional stress myocardial blood flow is mildly reduced.

scholarly journals Comorbidities associated with reduced myocardial flow reserve in non-obstructive disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Gurrola-Luna ◽  
J K Rojas-Sernaque ◽  
A J Barajas Paulin ◽  
I Carvajal-Juarez ◽  
J L Bermudez-Gonzalez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Flow Reserve ◽  
Microvascular Angina ◽  
Cardiac Computed Tomography Angiography ◽  
Early Stages ◽  
Female Sex ◽  
Flow Reserve ◽  
Pet Ct ◽  
Myocardial Flow ◽  
Severe Ischemia

Abstract Introduction Microvascular Dysfunction defined as a Myocardial Flow Reserve (MFR) &lt;2 or &lt;2.5 depending on the center, may present in the absence of significant obstruction (1,2); it is included as a diagnosis criteria of Microvascular Angina (MVA) (3,4) and is an independent risk factor associated with poor prognosis (5–7). Traditional Coronary Artery Disease (CAD)risk factors have also been associated with MVA (8–10), however, there is reduced data in latin populations with high prevalence of comorbidities. The aim of this study was to identify the comorbidities that alter MFR with 13N-ammonia Positron Emission Tomography/Cardiac Tomography (PET/CT) and Cardiac Computed Tomography Angiography (CCTA) in a cardiovascular imaging referral center. Methods Retrospective cross-sectional study of patients with suspected CAD in which both PET/CT and CCTA were performed. Inclusion:CCTA with obstruction &lt;50%. Exclusion: incomplete study, previous infarction or intervention. Clinical data was assessed. Mean (±DE) or median (interquartile range) to present continuous variables according to their distribution; T student or U Man Whitney to compare them. For each variable two groups were conformed depending on its presence or absence in order to compare MFR between them. Statistical analysis was performed with Statistical Package for Social Science (SPSs Inc, Chicago, IL; version 23.0) and GraphPad Prism version 9.0. p&lt;0.05 was considered as significant. Results 335 patients included. MFR difference for each variable: female sex, hypertension (HT), Type 2 diabetes (T2D) and smoking – Appendix 1. Significant MFR difference for HT (p=0.024) and T2D (p=0.046). Severe ischemia had significant MFR reduction (p=0.006); patients with both HT and mild ischemia (p=0.018) – Appendix 2. Discussion Individuals with HT and T2D had a significantly lower MFR, consistent with previous studies (8,9). Absence of correlation with other risk factors, such as smoking (10) and female sex (11); latter may be caused by a significant lower number of women (108 vs 227). Further analysis in this subgroup ought to be done. When comparing MFR between level-of-ischemia groups, microvascular function was not reduced until severe ischemia. Remarkably, if we analyze the coexistence of HT with ischemia, MFR is reduced even in patients with mild ischemia. This finding highlights the importance of HT which alters function in early stages even in the absence of significant obstruction. This is one of the first studies correlating MFR with comorbidities in our population. Limitations the retrospective nature of the study. Conclusions MFR non-invasive assessment by PET/CT allows identifying very early stages of MVD, even in asymptomatic patients and when there's no evidence of ischemia or CAD. Therefore, timely recognition of this problem is mandatory to implement action strategies to stop the triggered events' cascade. FUNDunding Acknowledgement Type of funding sources: None.

Quantification of myocardial blood flow and myocardial flow reserve with SPECT imaging technique

2018 ◽  
Vol 26 (1) ◽  
pp. 318-323 ◽  
Author(s):  
Thet Khaing ◽  
Ching Chiew Wong Raymond ◽  
Wan Xian Chan ◽  
Chen Hao ◽  
Siong Sung Wong
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Imaging Technique ◽  
Spect Imaging ◽  
Myocardial Flow Reserve ◽  
Flow Reserve ◽  
Myocardial Flow
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