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 -