Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 1;21(10):1105-1113.
doi: 10.1093/ehjci/jeaa192.

Incremental prognostic value of hybrid [15O]H2O positron emission tomography-computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology

Roel S Driessen  1 , Michiel J Bom  1 , Pepijn A van Diemen  1 , Stefan P Schumacher  1 , Remi M Leonora  1 , Henk Everaars  1 , Albert C van Rossum  1 , Pieter G Raijmakers  2 , Peter M van de Ven  3 , Cornelis C van Kuijk  2 , Adriaan A Lammertsma  2 , Juhani Knuuti  4 , Amir Ahmadi  5 , James K Min  6 , Jonathon A Leipsic  7 , Jagat Narula  5 , Ibrahim Danad  1 , Paul Knaapen  1
Affiliations

Incremental prognostic value of hybrid [15O]H2O positron emission tomography-computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology

Roel S Driessen et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: This study sought to determine the prognostic value of combined functional testing using positron emission tomography (PET) perfusion imaging and anatomical testing using coronary computed tomography angiography (CCTA)-derived stenosis severity and plaque morphology in patients with suspected coronary artery disease (CAD).

Methods and results: In this retrospective study, 539 patients referred for hybrid [15O]H2O PET-CT imaging because of suspected CAD were investigated. PET was used to determine myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenoses and high-risk plaque (HRP) morphology. Patients were followed up for the occurrence of all-cause death and non-fatal myocardial infarction (MI). During a median follow-up of 6.8 (interquartile range 4.8-7.8) years, 42 (7.8%) patients experienced events, including 23 (4.3%) deaths, and 19 (3.5%) MIs. Annualized event rates for normal vs. abnormal results of PET MBF, CCTA-derived stenosis, and HRP morphology were 0.6 vs. 2.1%, 0.4 vs. 2.1%, and 0.8 vs. 2.8%, respectively (P < 0.001 for all). Cox regression analysis demonstrated prognostic values of PET perfusion imaging [hazard ratio (HR) 3.75 (1.84-7.63), P < 0.001], CCTA-derived stenosis [HR 5.61 (2.36-13.34), P < 0.001], and HRPs [HR 3.37 (1.83-6.18), P < 0.001] for the occurrence of death or MI. However, only stenosis severity [HR 3.01 (1.06-8.54), P = 0.039] and HRPs [HR 1.93 (1.00-3.71), P = 0.049] remained independently associated.

Conclusion: PET-derived MBF, CCTA-derived stenosis severity, and HRP morphology were univariably associated with death and MI, whereas only stenosis severity and HRP morphology provided independent prognostic value.

Keywords: coronary artery disease; coronary computed tomography angiography; high-risk plaque morphology; myocardial blood flow; positron emission tomography; prognosis.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Distribution of hybrid PET-CT findings. Flowchart demonstrating the distribution of the hybrid PET-CT findings and revascularization performance among the three imaging parameters, i.e. PET perfusion abnormalities, CCTA-derived obstructive CAD, and CCTA-derived HRP. CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CT, computed tomography; HRP, high-risk plaque; PET, positron emission tomography.
Figure 2
Figure 2
Survival analyses for death and MI according to imaging findings. Kaplan–Meier curves for survival free from myocardial infarction and all-cause death according to PET perfusion, CCTA-derived stenosis grade, and CCTA-derived high-risk plaque. CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CT, computed tomography; HRP, high-risk plaque; MI, myocardial infarction; PET, positron emission tomography.
Figure 3
Figure 3
Survival analyses according to combined imaging findings. Kaplan–Meier curves demonstrating cumulative survival for death and MI according to combined hybrid PET-CT imaging findings. CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CT, computed tomography; HRP, high-risk plaque; MI, myocardial infarction; PET, positron emission tomography.
Figure 4
Figure 4
Short-term and long-term survival analyses according to combined imaging stratified by high-risk plaques. Landmark analysis with Kaplan–Meier curves demonstrating cumulative survival of death and MI for short-term (4 years) and long-term follow-up, according to combined high-risk plaque with obstructive stenosis (A) and with abnormal flow (B). Survival was not significantly different at 4 years for patients without high-risk plaques (HRP), regardless of obstructive stenosis (CT, P = 0.21) or impaired myocardial blood flow (PET, P = 0.11). CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CT, computed tomography; HRP, high-risk plaque; PET, positron emission tomography.
See this image and copyright information in PMC

Comment in

  • The prognostic value of plaque.
    Williams MC, Dweck MR. Williams MC, et al. Eur Heart J Cardiovasc Imaging. 2020 Oct 1;21(10):1114-1115. doi: 10.1093/ehjci/jeaa208. Eur Heart J Cardiovasc Imaging. 2020. PMID: 32959060 No abstract available.

References

    1. Newby DE, Adamson PD, Berry C, Boon NA, Dweck MR, Flather M. et al.; SCOT-HEART Investigators. Coronary CT angiography and 5-year risk of myocardial infarction. N Engl J Med 2018;379:924–33. - PubMed
    1. Hoffmann U, Ferencik M, Udelson JE, Picard MH, Truong QA, Patel MR. et al. Prognostic value of noninvasive cardiovascular testing in patients with stable chest pain: insights from the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Circulation 2017;135:2320–32. - PMC - PubMed
    1. Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y. et al. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. J Am Coll Cardiol 2015;66:337–46. - PubMed
    1. Ferencik M, Mayrhofer T, Bittner DO, Emami H, Puchner SB, Lu MT. et al. Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE Randomized Clinical Trial. JAMA Cardiol 2018;3:144–52. - PMC - PubMed
    1. Foy AJ, Dhruva SS, Peterson B, Mandrola JM, Morgan DJ, Redberg RF.. Coronary computed tomography angiography vs functional stress testing for patients with suspected coronary artery disease: a systematic review and meta-analysis. JAMA Intern Med 2017;177:1623–31. - PMC - PubMed

Publication types

MeSH terms