TY - JOUR
T1 - Quantitative myocardial perfusion evaluation with positron emission tomography and the risk of cardiovascular events in patients with coronary artery disease
T2 - A systematic review of prognostic studies
AU - Juárez-Orozco, Luis Eduardo
AU - Tio, Rene A.
AU - Alexanderson, Erick
AU - Dweck, Marc
AU - Vliegenthart, Rozemarijn
AU - El Moumni, Mostafa
AU - Prakken, Niek
AU - Gonzalez-Godinez, Ivan
AU - Slart, Riemer H.J.A.
N1 - Funding Information:
Conflict of interest: R.V. declares grants from the Dutch Organization for Scientific Research, outside of the submitted work. The rest of the authors have no relevant disclosures.
Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Aims To evaluate the prognostic value of quantitative myocardial perfusion imaging with positron emission tomography (PET) for adverse cardiovascular outcomes in patients with known or suspected coronary artery disease (CAD). Methods and results A search in MEDLINE and Embase was conducted for studies that evaluated (i) myocardial perfusion in absolute terms with PET, (ii) prognostic value for the development of major adverse cardiovascular events (MACE), cardiac death, and/or all-cause mortality, and (iii) patients with known or suspected CAD. Studies were divided according to the radiotracer utilized and their included population (patients with and without previous infarction). Comprehensive description and a selected instance of pooling were performed. Eight studies (n = 6804) were analysed and documented clear variability in population, quantitative PET variables operationalization [stress myocardial blood flow (sMBF) and flow reserve (MFR)], statistical covariate structure, follow-up, and radiotracer utilized. MFR was independently associated with MACE in eight studies [range of adjusted hazard ratios (HRs): 1.19-2.93]. The pooling instance demonstrated that MFR significantly associates with the development of MACEs (HR: 1.92 [1.29, 2.84]; P = 0.001). sMBF was only associated with MACE in two studies that evaluated it, and only one study documented sMBF as a better predictor than MFR. Conclusion This systematic review demonstrates the prognostic value of quantitative myocardial perfusion evaluated with PET, in the form of MFR and sMBF, for the development of major adverse cardiovascular outcomes in populations with known or suspected CAD. In the qualitative comparison, MFR seems to outperform sMBF as an independent prognostic factor. Evidence is still lacking for assessing quantitative PET for the occurrence of cardiac death and all-cause mortality. There is clear heterogeneity in predictor operationalization and study performances.
AB - Aims To evaluate the prognostic value of quantitative myocardial perfusion imaging with positron emission tomography (PET) for adverse cardiovascular outcomes in patients with known or suspected coronary artery disease (CAD). Methods and results A search in MEDLINE and Embase was conducted for studies that evaluated (i) myocardial perfusion in absolute terms with PET, (ii) prognostic value for the development of major adverse cardiovascular events (MACE), cardiac death, and/or all-cause mortality, and (iii) patients with known or suspected CAD. Studies were divided according to the radiotracer utilized and their included population (patients with and without previous infarction). Comprehensive description and a selected instance of pooling were performed. Eight studies (n = 6804) were analysed and documented clear variability in population, quantitative PET variables operationalization [stress myocardial blood flow (sMBF) and flow reserve (MFR)], statistical covariate structure, follow-up, and radiotracer utilized. MFR was independently associated with MACE in eight studies [range of adjusted hazard ratios (HRs): 1.19-2.93]. The pooling instance demonstrated that MFR significantly associates with the development of MACEs (HR: 1.92 [1.29, 2.84]; P = 0.001). sMBF was only associated with MACE in two studies that evaluated it, and only one study documented sMBF as a better predictor than MFR. Conclusion This systematic review demonstrates the prognostic value of quantitative myocardial perfusion evaluated with PET, in the form of MFR and sMBF, for the development of major adverse cardiovascular outcomes in populations with known or suspected CAD. In the qualitative comparison, MFR seems to outperform sMBF as an independent prognostic factor. Evidence is still lacking for assessing quantitative PET for the occurrence of cardiac death and all-cause mortality. There is clear heterogeneity in predictor operationalization and study performances.
KW - cardiovascular events
KW - coronary artery disease
KW - myocardial blood flow
KW - myocardial flow reserve
KW - myocardial perfusion
KW - prognostic value
KW - quantitative positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85056703518&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jex331
DO - 10.1093/ehjci/jex331
M3 - Article
C2 - 29293983
AN - SCOPUS:85056703518
SN - 2047-2404
VL - 19
SP - 1179
EP - 1187
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 10
ER -