Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of         82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference

Simon Winther; Laust Dupont Rasmussen; Salma Raghad Karim; Jelmer Westra; Jonathan Nørtoft Dahl; Jacob Hartmann Søby; Louise Nissen; Fabian Bøgild Lomstein; Morten Würtz; Jens Munch Sundbøll; June Anita Ejlersen; Jesper Mortensen; Lars Poulsen Tolbod; Hanne Maare Søndergaard; Nicolaj Christopher Lyng Hansson; Mette Nyegaard; Rebekka Vibjerg Jensen; Michael Alle Madsen; Evald Høj Christiansen; Lars Christian Gormsen; Morten Böttcher

doi:10.1161/CIRCIMAGING.124.017479

Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference

Simon Winther, Laust Dupont Rasmussen, Salma Raghad Karim, Jelmer Westra, Jonathan Nørtoft Dahl, Jacob Hartmann Søby, Louise Nissen, Fabian Bøgild Lomstein, Morten Würtz, Jens Munch Sundbøll, June Anita Ejlersen, Jesper Mortensen, Lars Poulsen Tolbod, Hanne Maare Søndergaard, Nicolaj Christopher Lyng Hansson, Mette Nyegaard, Rebekka Vibjerg Jensen, Michael Alle Madsen, Evald Høj Christiansen, Lars Christian GormsenMorten Böttcher

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

BACKGROUND: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (82Rb) versus [15O]H2O (15O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare 82Rb-PET versus 15O-water-PET head-to-head for diagnosing obstructive CAD. METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements. RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%. CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.

Original language	English
Article number	e017479
Journal	Circulation. Cardiovascular imaging
Pages (from-to)	e017479
ISSN	1941-9651
DOIs	https://doi.org/10.1161/CIRCIMAGING.124.017479
Publication status	E-pub / Early view - 3 Apr 2025

Keywords

Rubidium-82
chest pain
hemodyamics
humans
hyperemia

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10.1161/CIRCIMAGING.124.017479

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Winther, S., Rasmussen, L. D., Karim, S. R., Westra, J., Dahl, J. N., Søby, J. H., Nissen, L., Lomstein, F. B., Würtz, M., Sundbøll, J. M., Ejlersen, J. A., Mortensen, J., Tolbod, L. P., Søndergaard, H. M., Hansson, N. C. L., Nyegaard, M., Jensen, R. V., Alle Madsen, M., Christiansen, E. H., ... Böttcher, M. (2025). Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference. Circulation. Cardiovascular imaging, e017479. Article e017479. Advance online publication. https://doi.org/10.1161/CIRCIMAGING.124.017479

@article{823f512f78654bcfa978af42edc897fb,

title = "Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference",

abstract = "BACKGROUND: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (82Rb) versus [15O]H2O (15O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare 82Rb-PET versus 15O-water-PET head-to-head for diagnosing obstructive CAD. METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements. RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%. CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.",

keywords = "Rubidium-82, chest pain, hemodyamics, humans, hyperemia",

author = "Simon Winther and Rasmussen, {Laust Dupont} and Karim, {Salma Raghad} and Jelmer Westra and Dahl, {Jonathan N{\o}rtoft} and S{\o}by, {Jacob Hartmann} and Louise Nissen and Lomstein, {Fabian B{\o}gild} and Morten W{\"u}rtz and Sundb{\o}ll, {Jens Munch} and Ejlersen, {June Anita} and Jesper Mortensen and Tolbod, {Lars Poulsen} and S{\o}ndergaard, {Hanne Maare} and Hansson, {Nicolaj Christopher Lyng} and Mette Nyegaard and Jensen, {Rebekka Vibjerg} and {Alle Madsen}, Michael and Christiansen, {Evald H{\o}j} and Gormsen, {Lars Christian} and Morten B{\"o}ttcher",

year = "2025",

month = apr,

day = "3",

doi = "10.1161/CIRCIMAGING.124.017479",

language = "English",

pages = "e017479",

journal = "Circulation. Cardiovascular imaging",

issn = "1941-9651",

publisher = "Lippincott Williams and Wilkins Ltd.",

}

Winther, S , Rasmussen, LD , Karim, SR , Westra, J , Dahl, JN , Søby, JH , Nissen, L , Lomstein, FB , Würtz, M, Sundbøll, JM, Ejlersen, JA, Mortensen, J, Tolbod, LP , Søndergaard, HM, Hansson, NCL, Nyegaard, M, Jensen, RV, Alle Madsen, M, Christiansen, EH , Gormsen, LC & Böttcher, M 2025, 'Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference', Circulation. Cardiovascular imaging, pp. e017479. https://doi.org/10.1161/CIRCIMAGING.124.017479

Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference. / Winther, Simon ; Rasmussen, Laust Dupont ; Karim, Salma Raghad et al.
In: Circulation. Cardiovascular imaging, 03.04.2025, p. e017479.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference

AU - Winther, Simon

AU - Rasmussen, Laust Dupont

AU - Karim, Salma Raghad

AU - Westra, Jelmer

AU - Dahl, Jonathan Nørtoft

AU - Søby, Jacob Hartmann

AU - Nissen, Louise

AU - Lomstein, Fabian Bøgild

AU - Würtz, Morten

AU - Sundbøll, Jens Munch

AU - Ejlersen, June Anita

AU - Mortensen, Jesper

AU - Tolbod, Lars Poulsen

AU - Søndergaard, Hanne Maare

AU - Hansson, Nicolaj Christopher Lyng

AU - Nyegaard, Mette

AU - Jensen, Rebekka Vibjerg

AU - Alle Madsen, Michael

AU - Christiansen, Evald Høj

AU - Gormsen, Lars Christian

AU - Böttcher, Morten

PY - 2025/4/3

Y1 - 2025/4/3

N2 - BACKGROUND: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (82Rb) versus [15O]H2O (15O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare 82Rb-PET versus 15O-water-PET head-to-head for diagnosing obstructive CAD. METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements. RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%. CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.

AB - BACKGROUND: Myocardial perfusion imaging by positron emission tomography (PET) is recommended as a first-line test in stable patients with chest pain symptoms and as a selective second-line test after an abnormal coronary computed tomography angiography (CTA). It is, however, unknown whether the use of Rubidium-82 (82Rb) versus [15O]H2O (15O-water) affects the diagnostic performance in coronary artery disease (CAD). The aim of this study was to compare 82Rb-PET versus 15O-water-PET head-to-head for diagnosing obstructive CAD. METHODS: The study included consecutive patients (n=1000) referred for CTA with symptoms suggestive of obstructive CAD. Patients with suspected stenosis based on CTA were referred for both 82Rb-PET, 15O-water-PET, and subsequently invasive coronary angiography (ICA), including 3-vessel fractional flow reserve and coronary flow reserve measurements. RESULTS: In total, 196/270 (73%) patients with suspected stenosis on CTA completed 82Rb-PET, 15O-water-PET, and ICA. Myocardial blood flow measurements from 82Rb-PET and 15O-water-PET correlated strongly at rest (ρ, 0.62-0.69) but only moderately during hyperemia (ρ, 0.41-0.59). Only weak correlations were demonstrated between myocardial blood flow reserve by both PET tracers compared with ICA coronary flow reserve (ρ, 0.11-0.38). Hemodynamically obstructive CAD defined as ICA fractional flow reserve ≤0.80, was identified in 86/196 (44%) patients. Using predefined cutoffs, the diagnostic accuracies of 82Rb-PET versus 15O-water-PET were similar (sensitivity 69% [58-78%] versus 71% [60-80%], P=0.59; specificity 85% [76-91%] versus 77% [68-85%], P=0.12). Using ICA diameter stenoses >70% as a reference, only 48/196 (24%) patients had anatomically severe CAD, and 82Rb-PET and 15O-water-PET sensitivities increased to >85%. CONCLUSIONS: For detection of obstructive CAD by PET myocardial perfusion imaging, 82Rb versus 15O-water have similar diagnostic performance.

KW - Rubidium-82

KW - chest pain

KW - hemodyamics

KW - humans

KW - hyperemia

UR - http://www.scopus.com/inward/record.url?scp=105002744756&partnerID=8YFLogxK

U2 - 10.1161/CIRCIMAGING.124.017479

DO - 10.1161/CIRCIMAGING.124.017479

M3 - Journal article

C2 - 40177753

SN - 1941-9651

SP - e017479

JO - Circulation. Cardiovascular imaging

JF - Circulation. Cardiovascular imaging

M1 - e017479

ER -

Myocardial Perfusion Imaging With PET; A Head-to-Head Comparison of 82Rubidium Versus 15O-water Tracers Using Invasive Coronary Measurements as Reference

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