A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Determining Hemodynamically Significant Coronary Artery Disease : Patient-Specific Cutoffs in Quantitative Myocardial Blood Flow Using [15O]H2O PET Imaging
Tekijät: Roel Hoek, Pepijn A. van Diemen, Pieter G. Raijmakers, Roel S. Driessen, Yvemarie B.O. Somsen, Ruben W. de Winter, Ruurt A. Jukema, Jos W.R. Twisk, Lourens F.H.J. Robbers, Pim van der Harst, Antti Saraste, Mark Lubberink, Jens Sörensen, Paul Knaapen, Juhani Knuuti, Ibrahim Danad
Kustantaja: Society of Nuclear Medicine
Julkaisuvuosi: 2024
Journal: Journal of Nuclear Medicine
Tietokannassa oleva lehden nimi: Journal of nuclear medicine : official publication, Society of Nuclear Medicine
Lehden akronyymi: J Nucl Med
Vuosikerta: 65
Numero: 7
Aloitussivu: 1113
Lopetussivu: 1121
ISSN: 0161-5505
eISSN: 1535-5667
DOI: https://doi.org/10.2967/jnumed.123.267195
Verkko-osoite: https://jnm.snmjournals.org/content/early/2024/05/09/jnumed.123.267195
Currently, cutoffs of quantitative [15O]H2O PET to detect fractional flow reserve (FFR)-defined coronary artery disease (CAD) were derived from a single cohort that included patients without prior CAD. However, prior CAD, sex, and age can influence myocardial blood flow (MBF). Therefore, the present study determined the influence of prior CAD, sex, and age on optimal cutoffs of hyperemic MBF (hMBF) and coronary flow reserve (CFR) and evaluated whether cutoff optimization enhanced diagnostic performance of quantitative [15O]H2O PET against an FFR reference standard. Methods: Patients with chronic coronary symptoms underwent [15O]H2O PET and invasive coronary angiography with FFR. Optimal cutoffs for patients with and without prior CAD and subpopulations based on sex and age were determined. Results: This multicenter study included 560 patients. Optimal cutoffs were similar for patients with (n = 186) and without prior CAD (hMBF, 2.3 vs. 2.3 mL·min-1·g-1; CFR, 2.7 vs. 2.6). Females (n = 190) had higher hMBF cutoffs than males (2.8 vs. 2.3 mL·min-1·g-1), whereas CFRs were comparable (2.6 vs. 2.7). However, female sex-specific hMBF cutoff implementation decreased diagnostic accuracy as compared with the cutoff of 2.3 mL·min-1·g-1 (72% vs. 82%, P < 0.001). Patients aged more than 70 y (n = 79) had lower hMBF (1.7 mL·min-1·g-1) and CFR (2.3) cutoffs than did patients aged 50 y or less, 51-60 y, and 61-70 y (hMBF, 2.3-2.4 mL·min-1·g-1; CFR, 2.7). Age-specific cutoffs in patients aged more than 70 y yielded comparable accuracy to the previously established cutoffs (hMBF, 72% vs. 76%, P = 0.664; CFR, 80% vs. 75%, P = 0.289). Conclusion: Patients with and without prior CAD had similar [15O]H2O PET cutoffs for detecting FFR-defined significant CAD. Stratifying patients according to sex and age led to different optimal cutoffs; however, these values did not translate into an increased overall accuracy as compared with previously established thresholds for MBF.
