Cardiac Pet in Daily Practice for Risk Assessment in Patients with and without Coronary Artery Disease

Document Type

Conference Proceeding

Publication Date

9-22-2023

Publication Title

J Nucl Cardiol

Keywords

beta adrenergic receptor blocking agent, hydroxymethylglutaryl coenzyme A reductase inhibitor, metergoline, adult, aged, cardiovascular disease, complication, conference abstract, controlled study, coronary artery bypass graft, coronary artery disease, coronary flow reserve, diabetes mellitus, drug therapy, female, human, hypertension, major clinical study, male, positron emission tomography, retrospective study, risk assessment, single photon emission computed tomography, therapy

Abstract

Introduction: The use of positron emission tomography (PET) has steadily increased in coronary and non-coronary applications. PET is superior SPECT for the detection of multivessel coronary artery disease (CAD) especially with its capacity to quantify rest and peak stress left ventricular systolic function as well as coronary flow reserve. We present our initial experience with utilization of PET in unselected patients with and without known CAD and demonstrate the utility of key parameters in PET applicable widely in daily practice. Methods: We retrospectively reviewed patients who underwent cardiac PET between October 2019 and June 2021. Two groups were defined based on the presence or absence of CAD. Categorical variables are presented as frequencies (%) and compared with Chi-square while numerical variables are presented as Median (IQR) and compared with Mann-Whitney U test. Major cardiac events (MCE) included undergoing revascularization (PCI or CABG) and cardiovascular related deaths. Univariate and multivariate analysis were done for predictors of MCE. Results: Of 271 patients undergoing cardiac PET, 130 had no prior CAD (Grp 1) while 141 had CAD (Grp 2). Of the study population, 12.5% developed MCE, with the majority (8%) being from Grp 2. In both groups, patients who developed MCE had no statistically significant difference in age (median 67.5 vs 72.5), race, history of diabetes or baseline medications such as statins and beta blockers. In Grp 1, patients who developed MCE were more likely to be males (83.3% vs 16.7%, P = 0.008), had lower resting EF (42.5-55%, median 52%, P = 0.034) and at stress (51.5-58%, median 55%, P = 0.016), larger area of ischemia (41.7% with ischemic area[= 10, P<0.001), higher SSS (0-10, median of 6, P<0.001) and higher SDS (0-10, median of 6 , P<0.001). In Grp 2 patients who developed MCE were more likely to have hypertension (68.2% vs 31.8%, P<0.001), had lower EF at stress (36-58%, median 55%, P = 0.008), larger area of ischemia (59.1% with ischemic area[= 10, P<0.001), higher SSS (4-14, median of 8, P<0.001) and higher SDS (0-11, median of 7, P<0.001). There was no statistically significant difference in presence or absence of an infarction or transient ischemic dilation (TID) on PET in predicting MCE in both groups. SSS remained an independent predictor for MCE (P =<0.0001). Conclusion: Our study highlights that the use of PET carries a substantial value in predicting outcomes in patients with and without prior known CAD. Using PET derived data points helps identify patients at risk for MCE and should be factored into risk estimations and management decisions.

Volume

30

Issue

6

First Page

2929

Last Page

2930

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