Incremental prognostic value of hybrid [15O]H2O positron emission tomography-computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology
: Roel S Driessen, Michiel J Bom, Pepijn A van Diemen, Stefan P Schumacher, Remi M Leonora, Henk Everaars, Albert C van Rossum, Pieter G Raijmakers, Peter M van de Ven, Cornelis C van Kuijk, Adriaan A Lammertsma, Juhani Knuuti, Amir Ahmadi, James K Min, Jonathon A Leipsic, Jagat Narula, Ibrahim Danad, Paul Knaapen
Publisher: Oxford University Press
: 2020
EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
: European heart journal cardiovascular Imaging
: Eur Heart J Cardiovasc Imaging
: 21
: 10
: 1105
: 1113
: 9
: 2047-2404
: 2047-2412
DOI: https://doi.org/10.1093/ehjci/jeaa192
: https://research.utu.fi/converis/portal/detail/Publication/50617463
AimsThis study sought to determine the prognostic value of combined functional testing using positron emission tomography (PET) perfusion imaging and anatomical testing using coronary computed tomography angiography (CCTA)-derived stenosis severity and plaque morphology in patients with suspected coronary artery disease (CAD).Methods and resultsIn this retrospective study, 539 patients referred for hybrid [15O]H2O PET-CT imaging because of suspected CAD were investigated. PET was used to determine myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenoses and high-risk plaque (HRP) morphology. Patients were followed up for the occurrence of all-cause death and non-fatal myocardial infarction (MI). During a median follow-up of 6.8 (interquartile range 4.8–7.8) years, 42 (7.8%) patients experienced events, including 23 (4.3%) deaths, and 19 (3.5%) MIs. Annualized event rates for normal vs. abnormal results of PET MBF, CCTA-derived stenosis, and HRP morphology were 0.6 vs. 2.1%, 0.4 vs. 2.1%, and 0.8 vs. 2.8%, respectively (P < 0.001 for all). Cox regression analysis demonstrated prognostic values of PET perfusion imaging [hazard ratio (HR) 3.75 (1.84–7.63), P < 0.001], CCTA-derived stenosis [HR 5.61 (2.36–13.34), P < 0.001], and HRPs [HR 3.37 (1.83–6.18), P < 0.001] for the occurrence of death or MI. However, only stenosis severity [HR 3.01 (1.06–8.54), P = 0.039] and HRPs [HR 1.93 (1.00–3.71), P = 0.049] remained independently associated.ConclusionPET-derived MBF, CCTA-derived stenosis severity, and HRP morphology were univariably associated with death and MI, whereas only stenosis severity and HRP morphology provided independent prognostic value.
