Utility of ¹⁸F-Flurpiridaz PET Relative Flow Reserve in Differentiating Obstructive From Nonobstructive Coronary Artery Disease.

IF 7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2025-10-09 DOI:10.1161/CIRCIMAGING.125.018323

Diana M Lopez, Dan Huck, Sanjay Divakaran, Jenifer M Brown, Brittany Weber, Mark Lemley, Valerie Builoff, Aakash Shanbhag, Zhou Lan, Christopher Buckley, Mouaz H Al-Mallah, Sharmila Dorbala, Ron Blankstein, Piotr Slomka, Marcelo F Di Carli

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引用次数: 0

Abstract

Background: Absolute quantification of myocardial blood flow (MBF) on positron emission tomography perfusion imaging improves the identification of coronary artery disease (CAD). However, distinguishing MBF impairment due to obstructive CAD from nonobstructive CAD remains challenging. We aimed to evaluate the incremental diagnostic value of positron emission tomography derived relative flow reserve (RFR) in the diagnosis of obstructive CAD.

Methods: This is a post hoc analysis of the multicenter phase III trial of ¹⁸F-flurpiridaz positron emission tomography. Patients with available MBF quantification were included. Reduced stress MBF (sMBF) was defined as sMBF below the median (2.2 mL/min per gram). Obstructive CAD on quantitative invasive coronary angiography was defined as ≥70% stenosis. RFR was calculated as a ratio of the minimal segment sMBF over the highest reference vascular territory sMBF. RFR performance for predicting obstructive CAD was evaluated through receiver operating characteristic analysis and the net reclassification index of multivariable regression models.

Results: The study included 231 patients (71% male; 56% with established CAD) drawn from the original cohort of 755 trial participants. No patients had 3-vessel CAD. In a per-vessel-based analysis, 82% of vessels with reduced sMBF had no obstructive CAD on invasive coronary angiography. RFR was significantly lower for vessels with obstructive CAD (0.55 versus 0.80; P<0.0001). In vessels with reduced sMBF, RFR was independently associated with obstructive CAD even after accounting for stress total perfusion deficit and MFR (odds ratio, 3.08 [95% CI, 1.49-6.38]; P=0.002). Although the addition of RFR did not significantly improve discrimination (area under the curve, 0.806 versus 0.822; P=0.11), it significantly improved reclassification of vessels with and without obstructive CAD (net reclassification index, 0.93; obstructive CAD net reclassification index, 0.44; nonobstructive CAD net reclassification index, 0.49; P<0.0001).

Conclusions: RFR provides complementary diagnostic information beyond existing positron emission tomography parameters and may help refine the diagnosis of obstructive CAD in patients with reduced flows.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01347710.

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18f -氟吡唑PET相对血流储备在鉴别阻塞性与非阻塞性冠状动脉疾病中的应用

背景：利用正电子发射断层显像对心肌血流（MBF）进行绝对定量分析，可提高冠状动脉疾病（CAD）的诊断水平。然而，区分阻塞性CAD与非阻塞性CAD导致的MBF损伤仍然具有挑战性。我们旨在评估正电子发射断层扫描相对血流储备（RFR）在阻塞性CAD诊断中的增量诊断价值。方法：这是对18f -氟吡唑正电子发射断层扫描多中心III期试验的事后分析。纳入可用MBF量化的患者。降低应激MBF （sMBF）定义为sMBF低于中位数（2.2 mL/min / g）。定量有创冠状动脉造影诊断梗阻性CAD为狭窄≥70%。RFR计算为最小段sMBF与最高参考血管区域sMBF之比。通过受试者工作特征分析和多变量回归模型的净重分类指数来评估RFR预测阻塞性CAD的性能。结果：该研究纳入了231例患者（71%男性，56%确诊CAD），这些患者来自755名试验参与者的原始队列。无3支血管CAD患者。在一项基于血管的分析中，82%的sMBF降低的血管在有创冠状动脉造影中没有梗阻性CAD。阻塞性CAD血管的RFR显著降低（0.55 vs 0.80； PP=0.002）。虽然RFR的加入并没有显著提高辨别力（曲线下面积，0.806 vs 0.822， P=0.11），但显著提高了伴梗阻性CAD和非梗阻性CAD血管的重分类(净重分类指数，0.93；阻塞性CAD净重分类指数，0.44；非梗阻性CAD净重分类指数，0.49；结论：RFR提供了现有正电子发射断层扫描参数之外的补充诊断信息，可能有助于改进血流减少患者阻塞性CAD的诊断。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01347710。

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

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.