A stress PET myocardial perfusion imaging study (PET MPI) offers many different, unique, and complementary markers to assess the presence and severity of severe coronary artery disease (significant blockages in the vessels supplying blood flow to the heart). One such measure is quantification of left ventricular ejection fraction (LVEF) at peak stress and rest. Measurement of change in LVEF with stress on PET MPI, also known as PET LVEF reserve (difference between stress and rest LVEF) offers additional diagnostic and prognostic benefits beyond ischemia assessed on perfusion images.
Objectives
Our study aims to study whether PET LVEF-R can identify patients who benefit from invasive treatments such as revascularization.
Methods
We followed 14,649 patients who underwent 82Rb rest/stress PET MPI from January 2010 to January 2016. Adjusted Cox models were employed to predict all-cause death, focusing on the interplay between known coronary artery disease (CAD), LVEF-R, and 90-day revascularization.
Key Findings
Patients who had no change or a drop in their LVEF with stress (LVEF-R <=0) had a significant survival benefit if they underwent early revascularization within 90 days of the study if they did not have a history of heart attack, stents, or bypass surgery. This was in addition to the other information obtained from a stress PET MPI, such as presence of ischemia (perfusion defect) or decrease in blood flow to the myocardium (myocardial flow reserve). We propose a novel algorithm based on multiple different and complementary high-risk markers available with a stress PET MPI study to guide physicians on which patients would be a good candidate to refer for an invasive angiogram and benefit from potential revascularization.
Conclusions
Discover how a lack of change in LVEF with vasodilator stress PET MPI identifies patients who benefit from early revascularization and how multiple stress PET markers of ischemia can be used in combination to understand which patients are ideal candidates to be referred for invasive treatment.