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A systematic review on the role of absolute myocardial blood flow evaluation with positron emission tomography in predicting cardiovascular events

Session Best Posters session 3

Speaker Luis Eduardo Juarez-Orozco

Event : ESC Congress 2016

  • Topic : imaging
  • Sub-topic : Positron Emission Tomography (PET)
  • Session type : Best ePosters

Authors : L E Juarez-Orozco (Groningen,NL), R Tio (Groningen,NL), E Alexanderson (Mexico City,MX), M El Moumni (Groningen,NL), M Dweck (New York,US), RHJA Slart (Groningen,NL)

L.E. Juarez-Orozco1 , R. Tio2 , E. Alexanderson3 , M. El Moumni4 , M. Dweck5 , R.H.J.A. Slart1 , 1University Medical Center Groningen, Nuclear Medicine and Molecular Imaging - Groningen - Netherlands , 2University Medical Center Groningen, Cardiology - Groningen - Netherlands , 3National Institute of Cardiology Ignacio Chavez, Nuclear Cardiology - Mexico City - Mexico , 4University Medical Center Groningen, Vascular Surgery - Groningen - Netherlands , 5Mount Sinai Medical Center - New York - United States of America ,

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 448

Introduction: Coronary artery disease (CAD) and its outcomes constitute the leading cause of death in developed countries. Quantitative myocardial perfusion PET in absolute terms has demonstrated added diagnostic value in the detection of clinically significant CAD, however its prognostic value has not been systematically assessed. We performed a systematic review and meta-analysis of the value of absolute quantification of myocardial perfusion with PET for predicting adverse cardiovascular outcomes in patients with known or suspected CAD.

Research and methods: This study was conducted in accordance to the PRISMA statement following the Cochrane Methods recommendations. MEDLINE and Embase were searched for studies published up to December, 2015. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria (study design and measurement of myocardial perfusion in absolute terms in CAD). Hazard ratios from the multivariate analysis of each study for myocardial perfusion reserve (MPR) were reported and a meta-analysis was attempted to calculate a pooled effect size using random effects. Heterogeneity regarding population, methods and applied statistics were assessed. The present study was registered in the international database of prospectively registered systematic reviews in health - PROSPERO (CRD42016033938).

Results: Of 3,194 abstracts reviewed, 15 studies met the inclusion criteria of which 8 studies had appropriate data for the meta-analysis (n=5,023). The pooled effect size and 95% CIs for the described primary outcome by each of the 8 studies (all of which included a composite of cardiac death and one or more of the following: myocardial infarction, acute coronary syndrome, revascularization or heart failure) was 2.48 (1.53–4.00) with presence of statistical heterogeneity (I2 = 89%) while the pooled effect size for mayor adverse cardiovascular events (MACEs) (6 studies) was 1.81 (1.25–2.62) with presence of heterogeneity (I2 = 85%) as well. Heterogeneity between studies is attributed to methodological (PET scanning procedures and tracer utilization) and statistical evaluation of the effects reported (number and variables included in the survival analyses).

Conclusion: Myocardial perfusion reserve measured through quantitative PET imaging is consistently associated with an adverse prognosis for cardiovascular events. However, there is considerable variation and heterogeneity within the available studies. Standardization in quantitative myocardial perfusion PET procedures and analysis is needed to confirm its prognostic value.

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