TY - JOUR
T1 - Guiding early revascularization using [15O]H2O positron emission tomography myocardial perfusion imaging
T2 - impact of atrial fibrillation
AU - Madsen, S
AU - Kjaerulff, M L G
AU - Ejlersen, J A
AU - Nielsen, B R R
AU - Jakobsen, L
AU - Sörensen, J
AU - Tolbod, L P
AU - Gormsen, L C
PY - 2024/7/1
Y1 - 2024/7/1
N2 - Aims Myocardial perfusion imaging (MPI) using [15O]H2O positron emission tomography (PET) is used to guide the selection of patients with angina for invasive angiography and possible revascularization. Our study evaluated (i) whether atrial fibrillation (AF) reduces global hyperaemic myocardial blood flow (MBF) and (ii) whether [15O]H2O PET MPI effectively guides revascularization procedures for patients with ongoing AF. Methods We prospectively recruited 346 patients with angina and persistent or paroxysmal AF referred for baseline/hyperaemic and results [15O]H2O PET MPI. The primary outcome was revascularization within 3 months of MPI. In the analyses, patients were divided into four groups based on whether they had ongoing AF or sinus rhythm (SR) and whether they had previously documented coronary artery disease (CAD) or not. Thus, four groups were compared: SR-noCAD, AF-noCAD, SR-CAD, and AF-CAD. Hyperaemic MBF was affected by both ongoing AF and prior CAD [MBF (mL/min/g): 2.82 (SR-noCAD) vs. 2.12 (AF-noCAD) vs. 2.22 (SR-CAD) vs. 1.80 (AF-CAD), two-way analysis of variance P < 0.0001]. In multiple linear regression, ongoing AF was independently associated with reduced hyperaemic MBF. Every 0.1 mL/min/g decrease in hyperaemic MBF was associated with a 23% increase in odds of early revascularization. Receiver operating characteristic (ROC) analysis of vessel-specific hyperaemic MBF to predict early revascularization yielded the following areas under the ROC curve: SR-noCAD: 0.95 (P < 0.0001); AF-noCAD: 0.79 (P < 0.0001); SR-CAD: 0.78 (P < 0.0001); and AF-CAD: 0.88 (P < 0.0001). Conclusion Ongoing AF is associated with 19–25% reduced global hyperaemic MBF as measured by [15O]H2O MPI PET. Regardless, vessel-specific hyperaemic MBF still predicts early revascularization in patients with AF.
AB - Aims Myocardial perfusion imaging (MPI) using [15O]H2O positron emission tomography (PET) is used to guide the selection of patients with angina for invasive angiography and possible revascularization. Our study evaluated (i) whether atrial fibrillation (AF) reduces global hyperaemic myocardial blood flow (MBF) and (ii) whether [15O]H2O PET MPI effectively guides revascularization procedures for patients with ongoing AF. Methods We prospectively recruited 346 patients with angina and persistent or paroxysmal AF referred for baseline/hyperaemic and results [15O]H2O PET MPI. The primary outcome was revascularization within 3 months of MPI. In the analyses, patients were divided into four groups based on whether they had ongoing AF or sinus rhythm (SR) and whether they had previously documented coronary artery disease (CAD) or not. Thus, four groups were compared: SR-noCAD, AF-noCAD, SR-CAD, and AF-CAD. Hyperaemic MBF was affected by both ongoing AF and prior CAD [MBF (mL/min/g): 2.82 (SR-noCAD) vs. 2.12 (AF-noCAD) vs. 2.22 (SR-CAD) vs. 1.80 (AF-CAD), two-way analysis of variance P < 0.0001]. In multiple linear regression, ongoing AF was independently associated with reduced hyperaemic MBF. Every 0.1 mL/min/g decrease in hyperaemic MBF was associated with a 23% increase in odds of early revascularization. Receiver operating characteristic (ROC) analysis of vessel-specific hyperaemic MBF to predict early revascularization yielded the following areas under the ROC curve: SR-noCAD: 0.95 (P < 0.0001); AF-noCAD: 0.79 (P < 0.0001); SR-CAD: 0.78 (P < 0.0001); and AF-CAD: 0.88 (P < 0.0001). Conclusion Ongoing AF is associated with 19–25% reduced global hyperaemic MBF as measured by [15O]H2O MPI PET. Regardless, vessel-specific hyperaemic MBF still predicts early revascularization in patients with AF.
KW - Aged
KW - Angina Pectoris/diagnostic imaging
KW - Atrial Fibrillation/diagnostic imaging
KW - Cohort Studies
KW - Coronary Angiography/methods
KW - Coronary Artery Disease/diagnostic imaging
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Myocardial Perfusion Imaging/methods
KW - Myocardial Revascularization
KW - Oxygen Radioisotopes
KW - Positron-Emission Tomography/methods
KW - Prospective Studies
KW - ROC Curve
KW - Risk Assessment
KW - Severity of Illness Index
KW - coronary artery disease
KW - myocardial perfusion imaging
KW - atrial fibrillation
KW - myocardial blood flow
KW - [ O]H O PET MPI
UR - http://www.scopus.com/inward/record.url?scp=85196500504&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jeae043
DO - 10.1093/ehjci/jeae043
M3 - Journal article
C2 - 38376457
SN - 1525-2167
VL - 25
SP - 958
EP - 967
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 7
ER -