Comparison of the prognostic value of impaired stress myocardial blood flow, myocardial flow reserve, and myocardial flow capacity on low-dose Rubidium-82 SiPM PET/CT

BACKGROUND: The most reliable quantitative variable on Rubidium-82 ((82)Rb) 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 deliveri...

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Detalles Bibliográficos
Autores principales: Dietz, Matthieu, Kamani, Christel H., Allenbach, Gilles, Rubimbura, Vladimir, Fournier, Stephane, Dunet, Vincent, Treglia, Giorgio, Nicod Lalonde, Marie, Schaefer, Niklaus, Eeckhout, Eric, Muller, Olivier, Prior, John O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Original Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10371877/
https://www.ncbi.nlm.nih.gov/pubmed/36574175
http://dx.doi.org/10.1007/s12350-022-03155-6
Descripción
Sumario:BACKGROUND: The most reliable quantitative variable on Rubidium-82 ((82)Rb) 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. METHODS AND RESULTS: We prospectively enrolled 234 consecutive participants with suspected myocardial ischemia. Participants underwent (82)Rb 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 (MFC(severe)) 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 MFC(severe) > 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 MFC(severe) impairments (HR 2.81, p = 0.027). CONCLUSION: Using the latest SiPM PET technology with low-dose (82)Rb 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. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12350-022-03155-6.

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