Dataset Information

Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

ABSTRACT:

Purpose

To evaluate the prognostic value of myocardial perfusion PET in patients with and patients without diabetes mellitus.

Materials and methods

The authors performed a retrospective analysis of prospectively acquired data from a multicenter registry cohort of 7061 patients, including 1966 with diabetes mellitus, who underwent clinically indicated rest-stress rubidium 82 (⁸²Rb) myocardial perfusion PET. The mean patient age (±standard deviation) was 63.3 years ± 13. Of the 7061 patients, 3348 were women (47.4%), 2296 (32.5%) had known coronary artery disease, and 1895 (26.8%) had previously undergone revascularization. The primary end point was cardiac death (n = 169) assessed at a mean of 2.5 years ± 1.5. The authors used Cox proportional hazards models and risk reclassification measures stratified according to diabetes status.

Results

In multivariable models adjusting for established clinical predictors, increasing magnitude of stress myocardial perfusion abnormality was associated with greater risk of cardiac death in patients with diabetes (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.1, 16.8) for severely abnormal myocardium compared with normal myocardium. The addition of stress myocardial perfusion imaging results significantly improved the fit of a clinical model for predicting cardiac death in patients with and patients without diabetes. Myocardial perfusion PET improved risk reclassification for cardiac death in patients with diabetes (category-based net reclassification index: 0.39; 95% CI: 0.15, 0.60, P < .001). Among diabetic patients, an abnormal myocardial perfusion PET scan was associated with increased risk of cardiac death (HR: 4.4; 95% CI: 2.0, 9.7) in all important clinical subgroups based on age, sex, obesity, or prior revascularization.

Conclusion

In a large cohort of patients referred for clinical ⁸²Rb stress PET, myocardial perfusion imaging results provided incremental risk prediction of cardiac death in patients with and patients without diabetes mellitus.© RSNA, 2019Supplemental material is available for this article.

SUBMITTER: Skali H

PROVIDER: S-EPMC7970097 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

Skali Hicham H Di Carli Marcelo F MF Blankstein Ron R Chow Benjamin J BJ Beanlands Rob S RS Berman Daniel S DS Germano Guido G Min James K JK Merhige Michael M Williams Brent B Veledar Emir E Shaw Leslee J LJ Dorbala Sharmila S

Radiology. Cardiothoracic imaging 20190627 2

<h4>Purpose</h4>To evaluate the prognostic value of myocardial perfusion PET in patients with and patients without diabetes mellitus.<h4>Materials and methods</h4>The authors performed a retrospective analysis of prospectively acquired data from a multicenter registry cohort of 7061 patients, including 1966 with diabetes mellitus, who underwent clinically indicated rest-stress rubidium 82 (<sup>82</sup>Rb) myocardial perfusion PET. The mean patient age (±standard deviation) was 63.3 years ± 13. ...[more]

PMID: 33778500

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Project description:PurposeThe objective of this study was to assess the incremental value of myocardial wall motion and thickening compared with perfusion alone obtained from gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in diagnosing myocardial viability in patients with ischemic heart failure.MethodsEighty-three consecutive patients with ischemic heart failure who underwent both 99mTc-MIBI gated SPECT MPI and 18F-FDG positron emission tomography (PET) myocardial metabolic imaging were retrospectively enrolled. SPECT/PET myocardial viability was defined as the reference standard. Segmental myocardial perfusion, wall motion, and thickening were measured by an automated algorithm from gated SPECT MPI. Univariate and stepwise multivariate analysis were conducted to establish an optimal multivariate model for predicting hibernating myocardium and scar.ResultsAmong the 1411 segments evaluated, 774 segments had normal perfusion and 637 segments had decreased perfusion. The latter were classified by 18F-FDG PET into 338 hibernating segments and 299 scarred segments. The multivariate regression analysis showed that the model that combined myocardial perfusion uptake with wall motion and thickening scores had the optimal predictive efficiency to distinguish hibernating myocardium from scar in the segments with decreased perfusion. The model had the largest C-statistic (0.753 vs 0.666, P < 0.0001), and the global chi-square was increased from 53.281 to 111.234 when compared with perfusion alone (P < 0.001).ConclusionsAssessment of myocardial wall motion and thickening in addition to conventional perfusion uptake in the segments with decreased perfusion enables better differentiation of hibernating myocardium from scar in patients with ischemic heart failure. Considering wide availability and high cost-effectiveness, regional myocardial function integrated with perfusion on gated SPECT MPI has great promise to become a clinical tool in the assessment of myocardial viability.

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Dataset Information

Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

Purpose

Materials and methods

Results

Conclusion

Publications

Stress Myocardial Perfusion PET Provides Incremental Risk Prediction in Patients with and Patients without Diabetes.

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