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

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.

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Intra- and inter-operator repeatability of myocardial blood flow and myocardial flow reserve measurements using rubidium-82 pet and a highly automated analysis program

Journal of Nuclear Cardiology ◽

10.1007/s12350-010-9225-3 ◽

2010 ◽

Vol 17 (4) ◽

pp. 600-616 ◽

Cited By ~ 97

Author(s):

Ran Klein ◽

Jennifer M. Renaud ◽

Maria C. Ziadi ◽

Stephanie L. Thorn ◽

Andy Adler ◽

...

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Automated Analysis ◽

Myocardial Flow Reserve ◽

Analysis Program ◽

Flow Reserve ◽

Myocardial Flow ◽

Rubidium 82

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

BJR|case reports ◽

10.1259/bjrcr.20190046 ◽

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.

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

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.067 ◽

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.

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Entropy-based myocardial blood flow measurements using PET: a way to improve reproducibility

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.066 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

J Van Dalen ◽

SS Koenders ◽

BN Vendel ◽

PL Jager ◽

JD Van Dijk

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Flow Parameter ◽

Myocardial Flow Reserve ◽

Flow Measurements ◽

Shannon's Entropy ◽

Flow Reserve ◽

The Mean ◽

Myocardial Flow ◽

Rubidium 82

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose Myocardial blood flow (MBF) measurements using PET are increasingly used to guide the management of patients with (suspected) coronary artery disease (CAD). Day-to-day variability of these measurements is poor with a 21% standard deviation or 40% 95%-confidence interval [Reference: JACC Cardiovasc Imaging, 2017;10(5):565]. This limits clinical applicability in diagnosis, risk stratification and follow-up as these all depend on comparison of flow values with fixed cut-off values. We expect that reproducibility can be improved by combining flow measurements with the variation of flow values within the myocardium. As entropy is a measure of variability of the associated distribution, we compared the reproducibility of an entropy-based flow parameter with that of conventional myocardial flow reserve (MFR) measurements. Methods We performed a study using intra-individual comparison in 24 patients who underwent rest and regadenoson-induced stress myocardial perfusion imaging using Rubidium-82 on two different PET systems (PET1: Discovery 690, GE Healthcare, and PET2: Vereos, Philips Healthcare) within 3 weeks. MBF for both rest and stress was calculated using Lortie’s one-tissue compartment model (Corridor4DM, INVIA). MFR (ratio of MBF stress/rest) was determined for the myocardial as a whole (MFRglobal), for the three vascular territories: LAD, LCX and RCA (MFRregional) and for the 17 segments. Next, we calculated Shannon’s entropy to measure the variation of the 17 MFR segmental values. We multiplied Shannon’s entropy by the mean of the MFR segmental values resulting in an entropy-based MFR (MFRentropy). For each patient MFRglobal, MFRregional and MRFentropy were compared between both PET systems. For each of the three parameters the test-retest precision was calculated as the SD of the relative difference between measurements. Results The mean difference in MFR measurements between both cameras did not differ from zero (p > 0.05). Mean values for PET1 were MFRglobal = 2.4, MFRregional = 2.4 (LAD), 2.4 (LCX) and 2.5 (RCA), and MFRentropy = 2.4. For PET2 we found MFRglobal = 2.5, MFRregional = 2.5 (LAD), 2.4 (LCX) and 2.6 (RCA), and MFRentropy = 2.5. Test-retest precision was lower for MFRentropy with 11% compared to that of MFRglobal (21%), MFRregional LAD (22%), MFRregional LCX (23%) and MFRregional RCA (24%) (p < 0.01). Conclusion The reproducibility of myocardial flow reserve measurements using Rubidium-82 PET improved by a factor of 2 when an entropy-based flow parameter instead of global or regional MFR parameters is used. This entropy-based flow-parameter may be used to better discriminate ischemia from non-ischemia and may therefore improve CAD management.

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