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
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Figure 1 Event-Free Survival as a Function of Percent Myocardium Abnormal
Kaplan-Meier survival curves showing unadjusted cumulative survival free of cardiac events (CE) as a function of percent myocardium abnormal. Overall survival free of CE was best in the group with 0% abnormal myocardium. Event-free survival worsened with increasing percent abnormal myocardium.
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Figure 2 Event Rates in Patients With Normal and Abnormal LVEF Reserve
Annualized rates of cardiac events (CE) (cardiac death and nonfatal myocardial infarction) and all-cause death were lower in patients with left ventricular ejection fraction (LVEF) reserve  0% compared to those with LVEF reserve <0%. p < 0.001 for CE and all-cause death.
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Figure 3 Predicted Event-Free Survival as a Function of Ischemic Burden
The predicted event-free survival as a function of percent myocardium ischemic. The predicted survival (risk-adjusted) free of cardiac events was best in a patient with 0% myocardium ischemic. Survival worsened progressively with 10%, 20%, or 30% myocardium ischemic.
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Figure 4 Predicted Event-Free Survival as a Function of Rest LVEF and Ischemic Burden
The risk adjusted predicted survival free of cardiac events in a patient with varying degrees of left ventricular systolic dysfunction and no ischemia (A) or severe ischemia (B). The predicted survival free of cardiac events was best in a patient with an LVEF of 50%. Survival free of cardiac events was worse in a patient with an LVEF of 20% or 35%. For a given LVEF, survival free of cardiac events was worse in a patient with severe ischemia (20% ischemic myocardium, B) compared to a patient with no ischemia (0% myocardium ischemic, A).
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Figure 5 Event-Free Survival as a Function of LVEF Reserve
The risk-adjusted survival free of cardiac events in patients with normal and abnormal left ventricular ejection fraction (LVEF) reserve. Risk-adjusted survival free of cardiac events was significantly better in patients with an LVEF reserve of 0% compared to those with an LVEF reserve of <0%.
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