Details

Autor(en) / Beteiligte

• HERZOG, Bernhard A
• HUSMANN, Lars
• VALENTA, Ines
• GAEMPERLI, Oliver
• SIEGRIST, Patrick T
• TAY, Fabian M
• BURKHARD, Nina
• WYSS, Christophe A
• KAUFMANN, Philipp A

Titel

Long-Term Prognostic Value of 13N-Ammonia Myocardial Perfusion Positron Emission Tomography: Added Value of Coronary Flow Reserve

Ist Teil von

• Journal of the American College of Cardiology, 2009-07, Vol.54 (2), p.150-156

Ort / Verlag

New York, NY: Elsevier

Erscheinungsjahr

2009

Link zum Volltext

Quelle

Electronic Journals Library

Beschreibungen/Notizen

• The goal of this study was to assess the predictive value of myocardial perfusion imaging with (13)N-ammonia positron emission tomography (PET) and coronary flow reserve (CFR) on long-term prognosis in patients with suspected myocardial ischemia. No prognostic data exist on the predictive value of CFR and (13)N-ammonia PET. Perfusion and CFR were assessed in 256 patients using (13)N-ammonia PET, and follow-up was obtained in 245 (96%) patients. Sixteen early revascularized patients were excluded and 229 were assigned to normal versus abnormal perfusion or normal versus abnormal CFR (<2.0). Major adverse cardiac events (MACE) (cardiac death, nonfatal myocardial infarction, late revascularization, or hospitalization for cardiac reasons) were assessed using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors for cardiac events. During follow-up (5.4 +/- 2.2 years), 78 patients had at least 1 cardiac event, including 29 cardiac deaths. Abnormal perfusion (n = 126) was associated with a higher incidence of MACE (p < 0.001) and cardiac death (p < 0.05). In patients with normal perfusion, abnormal CFR was independently associated with a higher annual event rate over 3 years compared with normal CFR for MACE (1.4% vs. 6.3%; p < 0.05) and cardiac death (0.5% vs. 3.1%; p < 0.05). In abnormal perfusion, CFR remained predictive throughout the 10-year follow-up (p < 0.001). Perfusion findings in (13)N-ammonia PET and CFR are strong outcome predictors. CFR allows further risk stratification, suggesting a "warranty" period of 3 years if normal CFR is associated with normal perfusion. Conversely, in patients with abnormal perfusion, an impaired CFR has added value for predicting adverse outcomes.