Impact of Positron Emission Tomographic Myocardial Perfusion Imaging on Patient Selection for Revascularization

射血分数 医学 血运重建 心脏病学 冠状动脉疾病 内科学 心肌梗塞 心肌灌注成像 正电子发射断层摄影术 缺血性心肌病 核医学 心力衰竭
作者
Krishna Patel,A. Iain McGhie,Kevin Kennedy,Randall C. Thompson,John A. Spertus,Brett W. Sperry,Leslee J. Shaw,Timothy M. Bateman
出处
期刊:Journal of the American College of Cardiology [Elsevier]
卷期号:82 (17): 1662-1672 被引量:4
标识
DOI:10.1016/j.jacc.2023.08.027
摘要

Positron emission tomography (PET) myocardial perfusion imaging (MPI) quantifies left ventricular ejection fraction (LVEF) at peak stress. PET LVEF reserve (LVEF-R = stress LVEF - rest LVEF) offers diagnostic and prognostic value.The purpose of this study was to determine if PET LVEF-R identifies patients with survival benefit postrevascularization.We followed 14,649 unique consecutive patients undergoing 82Rb rest/stress PET MPI from January 2010 to January 2016 (excluding known cardiomyopathy). Adjusted Cox models were built to predict all-cause death, and the 3-way interaction of known coronary artery disease (CAD) (prior myocardial infarction/revascularization), LVEF-R, and 90-day revascularization was tested.Known CAD was present in 4,982 (34.0%). Ischemia was detected in 5,396 (36.8%; ≥10% in 1,909 [13%]). Mean LVEF-R was 4.2% ± 5.7%, and was ≤0, 1 to 5, and >5 in 3,349 (22.9%), 5,266 (35.9%), and 6,034 (41.2%). Over median follow-up of 3.4 years (IQR: 1.9-5.2 years), 1,324 (8.1%) had 90-day revascularization, and there were 2,192 (15.0%) deaths. In multivariable modeling, there was a significant 3-way interaction among known CAD, LVEF-R, and 90-day revascularization (P = 0.025), such that LVEF-R ≤0 identified patients with survival benefit with 90-day revascularization in those without prior CAD (interaction P = 0.005), independently beyond percent ischemia and myocardial flow reserve. Among patients with known CAD, LVEF-R was not prognostic of death (HR: 0.99; 95% CI: 0.98-1.02; P = 0.98).A lack of augmentation or drop in LVEF with vasodilator stress on PET MPI independently identifies patients who have better survival with revascularization within 90 days post-MPI compared with medical therapy, in absence of prior myocardial infarction or revascularization. Multiparametric assessment of ischemia with PET can optimize post-test management.
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