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Incremental prognostic value of hybrid PET-CT assessed myocardial blood flow, coronary stenosis severity and adverse plaque characteristics

Session Advanced PET & CT techniques for clinical practice

Speaker Michiel Bom

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Hybrid and Fusion Imaging
  • Session type : Abstract Session

Authors : MJ Bom (Amsterdam,NL), RS Driessen (Amsterdam,NL), PA Van Diemen (Amsterdam,NL), H Everaars (Amsterdam,NL), SP Schumacher (Amsterdam,NL), AC Van Rossum (Amsterdam,NL), PG Raijmakers (Amsterdam,NL), AA Lammertsma (Amsterdam,NL), J Knuuti (Turku,FI), A Ahmadi (New York,US), JK Min (New York,US), JA Leipsic (Vancouver,CA), J Narula (New York,US), I Danad (Amsterdam,NL), P Knaapen (Amsterdam,NL)

Authors:
MJ Bom1 , RS Driessen1 , PA Van Diemen1 , H Everaars1 , SP Schumacher1 , AC Van Rossum1 , PG Raijmakers1 , AA Lammertsma1 , J Knuuti2 , A Ahmadi3 , JK Min4 , JA Leipsic5 , J Narula3 , I Danad1 , P Knaapen1 , 1Amsterdam UMC - Location VUmc - Amsterdam - Netherlands (The) , 2Turku University Hospital - Turku - Finland , 3Icahn School of Medicine at Mount Sinai Hospital - New York - United States of America , 4Weill Cornell Medical College - New York - United States of America , 5University of British Columbia - Vancouver - Canada ,

Citation:

Background: Management of patients with suspected coronary artery disease (CAD) can be optimized with prognostic information derived from non-invasive imaging such as positron emission tomography (PET) perfusion imaging and coronary computed tomography angiography (CCTA). The aim of the present study was to determine the incremental prognostic value of combined functional testing using PET perfusion imaging and anatomical testing using CCTA-derived stenosis severity and morphological assessment of CCTA-derived plaque morphology.

Methods: In this retrospective study, 539 patients referred for hybrid [15O]H2O PET – CCTA imaging because of suspected CAD were investigated. PET perfusion imaging was used to determine hyperemic myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenosis and high-risk plaque morphology. Major adverse coronary events (MACE) included all-cause death, non-fatal myocardial infarction (MI), urgent revascularization and late non-urgent revascularization (i.e. not guided by initial diagnostic work-up with non-invasive imaging). Kaplan Meier analysis and Cox proportional hazard regression were used to evaluate the independent prognostic value of PET-derived MBF, CCTA-derived stenosis and CCTA-derived high-risk plaque.

Results: During a mean follow-up of 6.8 [4.8-7.9] years, 79 (14.7%) patients experienced MACE, including 23 (4.3%) deaths, 19 (3.5%) MIs, 8 (1.5%) urgent revascularizations and 29 (5.4%) late non-urgent revascularizations. Annualized event rates for normal vs. abnormal results of PET perfusion imaging, CCTA-derived stenosis and high-risk plaque morphology were 1.2% vs 4.1%, 0.6% vs 4.4%, and 1.7% vs 5.6%, respectively (p<0.001 for all). The combined use of these three imaging parameters resulted in excellent long-term risk prediction, with a MACE-free survival of 97% in patients with no positive imaging findings. In contrast, MACE-free survival was only 69% in patients in whom all imaging findings were positive (figure 1). Multivariate Cox proportional hazard regression demonstrated incremental prognostic value of PET perfusion imaging, CCTA-derived stenosis and CCTA-derived high-risk plaques for the occurrence of MACE (p<0.05 for all)

Conclusion: PET-derived myocardial blood flow and CCTA-derived stenosis severity and high-risk plaque morphology are independent long-term predictors of adverse cardiac events and provide incremental prognostic value. Combined functional, anatomical and morphological assessment may allow for improved risk stratification in patients with suspected CAD.

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