Comparative effectiveness of positron emission tomography and single-photon emission computed tomography myocardial perfusion imaging for predicting risk in patients with cardiometabolic disease

IF 3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology Pub Date : 2024-10-01 DOI:10.1016/j.nuclcard.2024.101908

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引用次数: 0

Abstract

Background

The epidemiology of coronary artery disease (CAD) has shifted, with increasing prevalence of cardiometabolic disease and decreasing findings of obstructive CAD on myocardial perfusion imaging (MPI). Coronary microvascular dysfunction (CMD), defined as impaired myocardial flow reserve (MFR) by positron emission tomography (PET), has emerged as a key mediator of risk. We aimed to assess whether PET MFR provides additive value for risk stratification of cardiometabolic disease patients compared with single-photon emission computed tomography (SPECT) MPI.

Methods

We retrospectively followed patients referred for PET, exercise SPECT, or pharmacologic SPECT MPI with cardiometabolic disease (obesity, diabetes, or chronic kidney disease) and without known CAD. We compared rates and hazards of composite major adverse cardiovascular events (MACEs) (annualized cardiac mortality or acute myocardial infarction) among propensity-matched PET and SPECT patients using Poisson and Cox regression. Normal SPECT was defined as a total perfusion deficit (TPD) of <5%, reflecting the absence of obstructive CAD. Normal PET was defined as a TPD of <5% plus an MFR of ≥2.0.

Results

Among 21,544 patients referred from 2006 to 2020, cardiometabolic disease was highly prevalent (PET: 2308 [67%], SPECT: 9984 [55%]) and higher among patients referred to PET (P < 0.001). Obstructive CAD findings (TPD > 5%) were uncommon (PET: 21% and SPECT: 11%). Conversely, impaired MFR on PET (<2.0) was common (62%). In a propensity-matched analysis over a median 6.4-year follow-up, normal PET identified low-risk (0.9%/year MACE) patients, and abnormal PET identified high-risk (4.2%/year MACE) patients with cardiometabolic disease; conversely, those with normal pharmacologic SPECT remained moderate-risk (1.6%/year, P < 0.001 compared to normal PET).

Conclusions

Cardiometabolic disease is common among patients referred for MPI and is associated with a heterogenous level of risk. Compared with pharmacologic SPECT, PET with MFR can detect nonobstructive CAD including CMD and can more accurately discriminate low-risk from higher-risk individuals.

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pet 和 spect mpi 预测心脏代谢疾病患者风险的效果比较。

背景：冠状动脉疾病（CAD）的流行病学发生了变化，心血管代谢疾病的发病率越来越高，而心肌灌注成像（MPI）发现的阻塞性冠状动脉疾病却越来越少。冠状动脉微血管功能障碍（CMD）通过正电子发射断层扫描（PET）被定义为心肌血流储备（MFR）受损，它已成为风险的一个关键介导因素。我们的目的是评估与单光子发射计算机断层扫描（SPECT）MPI 相比，正电子发射计算机断层扫描心肌血流储备是否能为心脏代谢疾病患者的风险分层提供附加价值：我们对转诊至 PET、运动 SPECT 或药物 SPECT MPI 的患有心脏代谢疾病（肥胖、糖尿病或慢性肾脏病）但未发现 CAD 的患者进行了回顾性跟踪。我们使用泊松回归和 Cox 回归比较了倾向匹配的 PET 和 SPECT 患者的复合 MACE（年化心脏死亡率或急性心肌梗死）发生率和危险度。正常 SPECT 被定义为总灌注不足 (TPD) 结果：在2006-2020年转诊的21544名患者中，心脏代谢疾病的发病率很高（PET：2308人[67%]，SPECT：9984人[55%]），在转诊到PET（P 5%）的患者中发病率较高（PET：21%，SPECT：11%），而在转诊到SPECT（P 5%）的患者中发病率较低（PET：21%，SPECT：11%）。相反，PET 显示的 MFR 受损（结论：心脏代谢疾病在转诊的 MPI 患者中很常见，且与不同的风险水平相关。与药物 SPECT 相比，正电子发射计算机断层显像与 MFR 可检测包括 CMD 在内的非阻塞性 CAD，并能更准确地区分低风险和高风险人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Nuclear Cardiology 医学-核医学

CiteScore

5.30

自引率

20.80%

发文量

249

审稿时长

4-8 weeks

期刊介绍： Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.