Abstract | BACKGROUND: METHODS AND RESULTS: A total of 2783 consecutive patients referred for rest/stress positron emission tomography were followed up for a median of 1.4 years (interquartile range, 0.7-3.2 years). The extent and severity of perfusion abnormalities were quantified by visual evaluation of myocardial perfusion images. Rest and stress myocardial blood flows were calculated with factor analysis and a 2-compartment kinetic model and were used to compute coronary flow reserve (coronary flow reserve equals stress divided by rest myocardial blood flow). The primary end point was cardiac death. Overall 3-year cardiac mortality was 8.0%. The lowest tertile of coronary flow reserve (<1.5) was associated with a 5.6-fold increase in the risk of cardiac death (95% confidence interval, 2.5-12.4; P<0.0001) compared with the highest tertile. Incorporation of coronary flow reserve into cardiac death risk assessment models resulted in an increase in the c index from 0.82 (95% confidence interval, 0.78-0.86) to 0.84 (95% confidence interval, 0.80-0.87; P=0.02) and in a net reclassification improvement of 0.098 (95% confidence interval, 0.025-0.180). Addition of coronary flow reserve resulted in correct reclassification of 34.8% of intermediate-risk patients (net reclassification improvement=0.487; 95% confidence interval, 0.262-0.731). Corresponding improvements in risk assessment for mortality from any cause were also demonstrated. CONCLUSION: Noninvasive quantitative assessment of coronary vasodilator function with positron emission tomography is a powerful, independent predictor of cardiac mortality in patients with known or suspected coronary artery disease and provides meaningful incremental risk stratification over clinical and gated myocardial perfusion imaging variables.
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Authors | Venkatesh L Murthy, Masanao Naya, Courtney R Foster, Jon Hainer, Mariya Gaber, Gilda Di Carli, Ron Blankstein, Sharmila Dorbala, Arkadiusz Sitek, Michael J Pencina, Marcelo F Di Carli |
Journal | Circulation
(Circulation)
Vol. 124
Issue 20
Pg. 2215-24
(Nov 15 2011)
ISSN: 1524-4539 [Electronic] United States |
PMID | 22007073
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Aged, 80 and over
- Blood Flow Velocity
(physiology)
- Cardiovascular Diseases
(diagnostic imaging, mortality, physiopathology)
- Coronary Circulation
(physiology)
- Death
- Exercise Test
(methods)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Myocardial Perfusion Imaging
(methods)
- Positron-Emission Tomography
(methods)
- Risk Assessment
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