JNC: Prognostic value of [99m]technetium-pyrophosphate single-photon emission computed tomography visual grade in patients with transthyretin cardiac amyloidosis on stabilization therapy (Q3_25)-JNC: Temporal changes in PET myocardial flow reserve: Implications for cardiovascular outcomes

JNC: Temporal changes in PET myocardial flow reserve: Implications for cardiovascular outcomes

Pdf Summary

This study retrospectively investigates the utility of serial measurements of myocardial flow reserve (MFR) in predicting cardiovascular outcomes in patients with coronary artery disease (CAD) using positron emission tomography (PET) myocardial perfusion imaging (MPI). Examining data from 474 patients who underwent 948 PET MPI studies at Yale New Haven Hospital from 2016 to 2022, the study categorizes patients based on MFR trajectories: low to low, low to high, high to low, and high to high. Key findings include: while overall MFR remained steady over time (2.1 initially and later), rest and stress flow values notably decreased on the second scan. Importantly, the MFR increased post-revascularization in a subset of 62 patients. Over a median follow-up period of 17 months, 12% of patients experienced major adverse cardiovascular events (MACE), such as death or myocardial infarction. The results indicate that MFR trajectory, particularly persistently low MFR, correlates with increased MACE risk. The study suggests that incorporating serial MFR and perfusion assessments enhances risk stratification beyond traditional clinical risk factors, with models incorporating these factors showing improved performance metrics. Although incorporating MFR offers improved patient stratification, the study acknowledges the modest incremental value of repeated MFR assessment for most patients and acknowledges potential confounding factors, such as changes in concurrent medication regimens. Further research, particularly large-scale multicenter studies, is recommended to validate these findings and explore their applicability in broader clinical contexts. These insights support the broader clinical integration of serial MFR assessments to improve patient management strategies in CAD.

Keywords

myocardial flow reserve

MFR trajectory

coronary artery disease

positron emission tomography

PET myocardial perfusion imaging

major adverse cardiovascular events

revascularization

risk stratification

serial measurements

clinical outcomes