[15O]H2O myocardial perfusion PET: Added value of relative stress perfusion deficit in the prediction of significant coronary artery stenosis in a mixed population

Peter Dall Mark; Eva Prescott; Lisbeth Marner; Peter Hovind; Martin Krakauer

doi:10.1016/j.nuclcard.2024.101880

[¹⁵O]H₂O myocardial perfusion PET: Added value of relative stress perfusion deficit in the prediction of significant coronary artery stenosis in a mixed population

J Nucl Cardiol. 2024 May 4:101880. doi: 10.1016/j.nuclcard.2024.101880. Online ahead of print.

Authors

Peter Dall Mark¹, Eva Prescott², Lisbeth Marner³, Peter Hovind⁴, Martin Krakauer⁴

Affiliations

¹ Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. Electronic address: peter.dall.mark.01@regionh.dk.
² Department of Cardiology, Copenhagen University Hospital - Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
³ Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.

PMID: 38710439
DOI: 10.1016/j.nuclcard.2024.101880

Abstract

Background: It remains unknown whether estimation of the relative stress perfusion deficit offers added value in the prediction of significant coronary artery stenosis in myocardial perfusion imaging with [¹⁵O]H₂O PET in a population with high prevalence of established cardiac disease.

Methods: During eight months, we consecutively included all patients undergoing [¹⁵O]H₂O PET and subsequent invasive coronary angiography (ICA). Significant stenosis was defined from ICA as fractional flow reserve ≤0.8 or coronary artery narrowing of ≥70%. We calculated absolute and relative total perfusion deficits (aTPD and rTPD, respectively) as semiquantitative measures of the extent and severity of reduced stress perfusion. A multivariate logistic regression analysis was performed to test the adjusted associations (odds ratio (OR) with 95% CI) with significant coronary artery stenosis.

Results: Of 800 patients undergoing [¹⁵O]H₂O PET, 144 underwent ICA, where 142 patients had an aTPD ≥3% and 79 (55%) of these had at least one significant stenosis. In an adjusted analysis rTPD (OR_{10% increase} = 2.12 (1.44-3.12), P<0.001), previous coronary artery bypass grafting (CABG) (OR = 0.11 (0.03-0.36), P<0.001) and reduced left ventricular ejection fraction (LVEF) (OR = 0.25 (0.08-0.84), P=0.02) were independently associated with significant stenosis, whereas the association with aTPD (OR_{10% increase} = 1.14 (0.98-1.32), P=0.08) was modest.

Conclusions: In the presence of an absolute perfusion deficit (aTPD ≥3%), rTPD may improve the prediction of significant stenosis in a heterogeneous population of patients examined with [¹⁵O]H₂O PET. Furthermore, previous CABG and reduced LVEF are associated with non-stenotic perfusion deficiencies suggesting caution when interpreting myocardial perfusion imaging in such patients.

Keywords: [(15)O]H(2)O PET; myocardial perfusion imaging; relative flow reserve; total perfusion deficit.