Guiding early revascularization using [15O]H2O positron emission tomography myocardial perfusion imaging: impact of atrial fibrillation

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 -