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. 2023 Aug;30(4):1385-1395.
doi: 10.1007/s12350-022-03155-6. Epub 2022 Dec 27.

Comparison of the prognostic value of impaired stress myocardial blood flow, myocardial flow reserve, and myocardial flow capacity on low-dose Rubidium-82 SiPM PET/CT

Matthieu Dietz  1   2 , Christel H Kamani  1   3 , Gilles Allenbach  1   4 , Vladimir Rubimbura  3 , Stephane Fournier  3   5 , Vincent Dunet  5   6 , Giorgio Treglia  1   5   7   8 , Marie Nicod Lalonde  1   5 , Niklaus Schaefer  1   5 , Eric Eeckhout  3   5 , Olivier Muller  3   5 , John O Prior  9   10
Affiliations

Comparison of the prognostic value of impaired stress myocardial blood flow, myocardial flow reserve, and myocardial flow capacity on low-dose Rubidium-82 SiPM PET/CT

Matthieu Dietz et al. J Nucl Cardiol. 2023 Aug.

Abstract

Background: The most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE) has not been characterized with low-dose silicon photomultipliers (SiPM) technology, which allows halving injected activity and radiation dose delivering less than 1.0 mSv in a 70-kg individual.

Methods and results: We prospectively enrolled 234 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT (5 MBq/kg) and were followed up for MACE over 652 days (interquartile range 559-751 days). For each participant, global stress myocardial blood flow (stress MBF), global myocardial flow reserve (MFR), and regional severely reduced myocardial flow capacity (MFCsevere) were measured. The Youden index was used to select optimal thresholds. In multivariate analysis after adjustments for clinical risk factors, reduced global stress MBF < 1.94 ml/min/g, reduced global MFR < 1.98, and regional MFCsevere > 3.2% of left ventricle emerged all as independent predictors of MACE (HR 4.5, 3.1, and 3.67, respectively, p < 0.001). However, only reduced global stress MBF remained an independent prognostic factor for MACE after adjusting for clinical risk factors and the combined use of global stress MBF, global MFR, and regional MFCsevere impairments (HR 2.81, p = 0.027).

Conclusion: Using the latest SiPM PET technology with low-dose 82Rb halving the standard activity to deliver < 1 mSv for a 70-kg patient, impaired global stress MBF, global MFR, and regional MFC were powerful predictors of cardiovascular events, outperforming traditional cardiovascular risk factors. However, only reduced global stress MBF independently predicted MACE, being superior to global MFR and regional MFC impairments.

Keywords: Quantitative myocardial perfusion; SiPM PET/CT; low-dose rubidium-82; major adverse cardiovascular events; myocardial flow capacity; outcome.

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Conflict of interest statement

Dr. Dietz has nothing to disclose. Dr. Kamani has nothing to disclose. Dr. Allenbach has nothing to disclose. Dr. Rubimbura has nothing to disclose. Dr. Fournier has nothing to disclose. Dr. Dunet has nothing to disclose. Dr. Treglia has nothing to disclose. Dr. Nicod Lalonde has nothing to disclose. Dr. Schaefer has nothing to disclose. Dr. Eeckhout has nothing to disclose. Dr. Muller has nothing to disclose. Dr. Prior has nothing to disclose. The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart. CABG - coronary artery bypass graft; CT - computed tomography; PET - positron emission tomography; 82Rb - rubidium-82; SiPM - silicon photomultipliers with digital readout
Figure 2
Figure 2
MACE-free survival curves (n = 234) according to global stress MBF (A), global MFR (B), and MFCsevere (C), based on optimal thresholds using the Youden Index. MACE - major adverse cardiovascular event; MBF - myocardial blood flow; MFC - myocardial flow capacity; MFR - myocardial flow reserve
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