DOI: 10.1007/s00259-017-3878-yPages: 1-11

Prognostic value of vasodilator response using rubidium-82 positron emission tomography myocardial perfusion imaging in patients with coronary artery disease

1. University of Ottawa Heart Institute, Canada, Department of Medicine (Cardiology)

2. Brigham and Women’s Hospital, Division of Cardiovascular Medicine and Division of Nuclear Medicine

3. Niagara Falls Memorial Medical Center, Departments of Cardiology, Internal Medicine, and Nuclear Medicine

4. Geisinger Medical Center, Department of Center for Health Research

5. Emory University School of Medicine, Department of Medicine

6. Weill Cornell Medical College, Department of Radiology and Department of Imaging

7. University of Ottawa Heart Institute, Cardiovascular Research Methods Centre

8. University of Ottawa, Department of Radiology

9. Cedars-Sinai Medical Center, Department of Imaging

Correspondence to:
Benjamin J. W. Chow
Tel: 613-761-4044
Email: bchow@ottawaheart.ca

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Abstract

Background

Prognostic value of positron emission tomography (PET) myocardial perfusion imaging (MPI) is well established. There is paucity of data on how the prognostic value of PET relates to the hemodynamic response to vasodilator stress. We hypothesize that inadequate hemodynamic response will affect the prognostic value of PET MPI.

Methods and results

Using a multicenter rubidium (Rb)-82 PET registry, 3406 patients who underwent a clinically indicated rest/stress PET MPI with a vasodilator agent were analyzed. Patients were categorized as, “responders” [increase in heart rate ≥ 10 beats per minute (bpm) and decrease in systolic blood pressure (SBP) ≥10 mmHg], “partial responders” (either a change in HR or SBP), and “non-responders” (no change in HR or SBP). Primary outcome was all-cause death (ACD), and secondary outcome was cardiac death (CD). Ischemic burden was measured using summed stress score (SSS) and % left ventricular (LV) ischemia. After a median follow-up of 1.68 years (interquartile range = 1.17- 2.55), there were 7.9% (n = 270) ACD and 2.6% (n = 54) CD. Responders with a normal PET MPI had an annualized event rate (AER) of 1.22% (SSS of 0–3) and 1.58% (% LV ischemia = 0). Partial and non-responders had higher AER with worsening levels of ischemic burden. In the presence of severe SSS ≥12 and LV ischemia of ≥10%, partial responders had an AER of 10.79% and 10.36%, compared to non-responders with an AER of 19.4% and 12.43%, respectively. Patient classification was improved when SSS was added to a model containing clinical variables (NRI: 42%, p < 0.001) and responder category was added (NRI: 61%, p < 0.001). The model including clinical variables, SSS and hemodynamic response has good discrimination ability (Harrell C statistics: 0.77 [0.74–0.80]).

Conclusion

Hemodynamic response during a vasodilator Rb-82 PET MPI is predictive of ACD. Partial and non-responders may require additional risk stratification leading to altered patient management.

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  • Accepted: Nov 6, 2017
  • Online: Nov 27, 2017

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