Incremental Prognostic Value of Gated Rb-82 Positron Emission Tomography Myocardial Perfusion Imaging Over Clinical Variables and Rest LVEF
Sharmila Dorbala, MD*, ,*,
Rory Hachamovitch, MD, MSc ,
Zelmira Curillova, MD*,,
Deepak Thomas, MD*,
Divya Vangala*,
Raymond Y. Kwong, MD,
Marcelo F. Di Carli, MD*,
* Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
Los Angeles, California
* Reprint requests and correspondence: Dr. Sharmila Dorbala, Brigham and Women's Hospital, Cardiovascular Faculty Offices, Shapiro 5, Room 128, 70 Francis Street, Boston, Massachusetts 02115 (Email: sdorbala{at}partners.org).
Objectives: This investigation sought to study the incremental value of gated rubidium (Rb)-82 positron emission tomography (PET) myocardial perfusion imaging (MPI) over clinical variables for predicting survival and future cardiac events.
Background: The prognostic value of Rb-82 PET-MPI and left ventricular ejection fraction (LVEF) reserve (stress minus rest LVEF) is not well defined.
Methods: 1,432 consecutive patients undergoing gated rest/vasodilator stress rubidium-82 PET were followed up for at least 1 year. Of these, rest and peak stress LVEF and LVEF reserve were available in 985 patients. Cardiac events (CE) including cardiac death or nonfatal myocardial infarction and all-cause death were assessed.
Results: Over a mean follow-up of 1.7 ± 0.7 years, 83 (5.8%) CE and 140 (9.7%) all-cause death were observed. There was an increase in risk for both end points with an increasing percentage of abnormal and ischemic myocardium. With normal, mild, moderate, or severely ischemic scans, the observed annualized rates of CE were 0.7%, 5.5%, 5%, and 11% and of all-cause death were 3.3%, 7.2%, 6.9%, and 12.5%, respectively. In 985 patients with peak stress gated data, the observed annualized rates of CE (2.1% vs. 5.3%, p < 0.001) and all-cause death (4.3% vs. 9.2%, p < 0.001) were higher in patients with an LVEF reserve <0% compared with those with an LVEF reserve  0%. On Cox proportional hazards analysis, after consideration of clinical, historical, and rest LVEF information, stress PET results and LVEF reserve yielded incremental prognostic value with respect to both CE and all-cause death.
Conclusions: Vasodilator stress Rb-82 PET-MPI provides incremental prognostic value to historical/clinical variables and rest LVEF to predict survival free of CE and all-cause death. An increasing percentage of ischemia on PET-MPI is associated with an increase in the risk of CE and all-cause death. Left ventricular ejection fraction reserve provides significant independent and incremental value to Rb-82 MPI for predicting the risk of future adverse events.
Key Words: prognosis • imaging • tomography
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Abbreviations and Acronyms
| | CAD = coronary artery disease | | CE = cardiac events | | CT = computed tomography | | EF = ejection fraction | | LV = left ventricular | | LVEF = left ventricular ejection fraction | | MI = myocardial infarction | | MPI = myocardial perfusion imaging | | PET = positron emission tomography | | Rb = rubidium | | ROC = receiver-operator characteristic | | SDS = summed difference score | | SPECT = single-photon emission computed tomography | | SRS = summed rest score | | SSS = summed stress score |
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