Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis.
Coronary artery disease
Meta-analysis
Myocardial perfusion imaging
PET
Journal
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
ISSN: 1532-6551
Titre abrégé: J Nucl Cardiol
Pays: United States
ID NLM: 9423534
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
23
07
2019
accepted:
06
12
2019
pubmed:
26
12
2019
medline:
8
2
2022
entrez:
26
12
2019
Statut:
ppublish
Résumé
We performed a meta-meta-analysis to evaluate the prognostic value of coronary flow reserve (CFR) assessed by cardiac positron emission tomography (PET) imaging in patients with suspected or known coronary artery disease (CAD). Studies published until April 2019 were identified by database search. We included studies if they evaluated CFR by PET providing data on adjusted hazard ratio (HR) for the occurrence of adverse events. Annualized event rates were calculated and the incidence rate ratios with 95% confidence interval (CI) were estimated to compare patients with impaired and preserved CFR. We identified 13 eligible articles including 11,867 patients with a follow-up ranging from 0.6 to 7.1 years. The HR for the occurrence of major adverse cardiac events (MACE) was reported in 11 studies and pooled HR was 1.93 (95% CI 1.65-2.27). The HR for the occurrence of hard events was reported in 5 studies and pooled HR was 3.11 (95% CI 1.88-5.14). Six studies reported data useful to calculate separately the incidence rate of MACE in patients with preserved and impaired CFR and pooled IRR was 2.26 (CI 95% 1.79-2.85). Three studies reported data useful to calculate separately the incidence rate of hard events in patients with preserved and impaired CFR and pooled IRR was 4.12 (CI 95% 3.08-5.51). At meta-regression analysis, we found an association between HR for MACE and gender, diabetes and hypertension, while no significant association was found between HR for hard events and demographic and clinical variables. In patients with suspected or known CAD, an impaired CFR is associated with adverse cardiovascular events. However, the large heterogeneity in study population underlines the need for further investigations to maximize the prognostic role of CFR.
Sections du résumé
BACKGROUND
BACKGROUND
We performed a meta-meta-analysis to evaluate the prognostic value of coronary flow reserve (CFR) assessed by cardiac positron emission tomography (PET) imaging in patients with suspected or known coronary artery disease (CAD).
METHODS
METHODS
Studies published until April 2019 were identified by database search. We included studies if they evaluated CFR by PET providing data on adjusted hazard ratio (HR) for the occurrence of adverse events. Annualized event rates were calculated and the incidence rate ratios with 95% confidence interval (CI) were estimated to compare patients with impaired and preserved CFR.
RESULTS
RESULTS
We identified 13 eligible articles including 11,867 patients with a follow-up ranging from 0.6 to 7.1 years. The HR for the occurrence of major adverse cardiac events (MACE) was reported in 11 studies and pooled HR was 1.93 (95% CI 1.65-2.27). The HR for the occurrence of hard events was reported in 5 studies and pooled HR was 3.11 (95% CI 1.88-5.14). Six studies reported data useful to calculate separately the incidence rate of MACE in patients with preserved and impaired CFR and pooled IRR was 2.26 (CI 95% 1.79-2.85). Three studies reported data useful to calculate separately the incidence rate of hard events in patients with preserved and impaired CFR and pooled IRR was 4.12 (CI 95% 3.08-5.51). At meta-regression analysis, we found an association between HR for MACE and gender, diabetes and hypertension, while no significant association was found between HR for hard events and demographic and clinical variables.
CONCLUSION
CONCLUSIONS
In patients with suspected or known CAD, an impaired CFR is associated with adverse cardiovascular events. However, the large heterogeneity in study population underlines the need for further investigations to maximize the prognostic role of CFR.
Identifiants
pubmed: 31875285
doi: 10.1007/s12350-019-02000-7
pii: 10.1007/s12350-019-02000-7
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
904-918Références
van de Hoef TP, Echavarría-Pinto M, van Lavieren MA, Meuwissen M, Serruys PW, Tijssen JG, et al. Diagnostic and prognostic implications of coronary flow capacity: a comprehensive cross-modality physiological concept in ischemic heart disease. JACC Cardiovasc Interv 2015;8:1670-80.
doi: 10.1016/j.jcin.2015.05.032
Camici PG, d’Amati G, Rimoldi O. Coronary microvascular dysfunction: mechanisms and functional assessment. Nat Rev Cardiol 2015;12:48-62.
doi: 10.1038/nrcardio.2014.160
Assante R, Zampella E, Arumugam P, Acampa W, Imbriaco M, Tout D, et al. Quantitative relationship between coronary artery calcium and myocardial blood flow by hybrid rubidium-82 PET/CT imaging in patients with suspected coronary artery disease. J Nucl Cardiol 2017;24:494-501.
doi: 10.1007/s12350-015-0359-1
Assante R, Acampa W, Zampella E, Arumugam P, Nappi C, Gaudieri V, et al. Prognostic value of atherosclerotic burden and coronary vascular function in patients with suspected coronary artery disease. Eur J Nucl Med Mol Imaging 2017;44:2290-8.
doi: 10.1007/s00259-017-3800-7
Naya M, Murthy VL, Blankstein R, Sitek A, Hainer J, Foster C, et al. Quantitative relationship between the extent and morphology of coronary atherosclerotic plaque and downstream myocardial perfusion. J Am Coll Cardiol 2011;58:1807-16.
doi: 10.1016/j.jacc.2011.06.051
Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol 2009;54:150-6.
doi: 10.1016/j.jacc.2009.02.069
Ziadi MC, Dekemp RA, Williams KA, Guo A, Chow BJ, Renaud JM, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol 2011;58:740-8.
doi: 10.1016/j.jacc.2011.01.065
Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215-24.
doi: 10.1161/CIRCULATIONAHA.111.050427
Brainin P, Frestad D, Prescott E. The prognostic value of coronary endothelial and microvascular dysfunction in subjects with normal or non-obstructive coronary artery disease: a systematic review and meta-analysis. Int J Cardiol 2018;254:1-9.
doi: 10.1016/j.ijcard.2017.10.052
Taqueti VR, Hachamovitch R, Murthy VL, Naya M, Foster CR, Hainer J, et al. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation 2015;6(131):19-27.
doi: 10.1161/CIRCULATIONAHA.114.011939
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
doi: 10.1371/journal.pmed.1000097
Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 2006;144:427-37.
doi: 10.7326/0003-4819-144-6-200603210-00010
Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007;8:16.
doi: 10.1186/1745-6215-8-16
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.
doi: 10.1016/0197-2456(86)90046-2
Cleophas TJ, Zwinderman AH. Meta-analysis. Circulation 2007;115:2870-5.
doi: 10.1161/CIRCULATIONAHA.105.594960
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-58.
doi: 10.1002/sim.1186
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.
doi: 10.1136/bmj.315.7109.629
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010;36:1-48.
doi: 10.18637/jss.v036.i03
Tio RA, Dabeshlim A, Siebelink HM, de Sutter J, Hillege HL, Zeebregts CJ, et al. Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients with ischemic heart disease. J Nucl Med 2009;50:214-9.
doi: 10.2967/jnumed.108.054395
Fukushima K, Javadi MS, Higuchi T, Lautamäki R, Merrill J, Nekolla SG, et al. Prediction of short-term cardiovascular events using quantification of global myocardial flow reserve in patients referred for clinical 82Rb PET perfusion imaging. J Nucl Med 2011;52:726-32.
doi: 10.2967/jnumed.110.081828
Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, et al. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 2014;129:2518-27.
doi: 10.1161/CIRCULATIONAHA.113.008507
Majmudar MD, Murthy VL, Shah RV, Kolli S, Mousavi N, Foster CR, et al. Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes. Eur Heart J Cardiovasc Imaging 2015;16:900-9.
doi: 10.1093/ehjci/jev012
Taqueti VR, Everett BM, Murthy VL, Gaber M, Foster CR, Hainer J, et al. Interaction of impaired coronary flow reserve and cardiomyocyte injury on adverse cardiovascular outcomes in patients without overt coronary artery disease. Circulation 2015;131:528-35.
doi: 10.1161/CIRCULATIONAHA.114.009716
Gupta A, Taqueti VR, van de Hoef TP, Bajaj NS, Bravo PE, Murthy VL, et al. Integrated noninvasive physiological assessment of coronary circulatory function and impact on cardiovascular mortality in patients with stable coronary artery disease. Circulation 2017;136:2325-36.
doi: 10.1161/CIRCULATIONAHA.117.029992
Taqueti VR, Solomon SD, Shah AM, Desai AS, Groarke JD, Osborne MT, et al. Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction. Eur Heart J 2018;39:840-9.
doi: 10.1093/eurheartj/ehx721
Gebhard C, Fiechter M, Herzog BA, Lohmann C, Bengs S, Treyer V, et al. Sex differences in the long-term prognostic value of (13)N-ammonia myocardial perfusion positron emission tomography. Eur J Nucl Med Mol Imaging 2018;45:1964-74.
doi: 10.1007/s00259-018-4046-8
Spruance SL, Reid JE, Grace M, Samore M. Hazard ratio in clinical trials. Antimicrob Agents Chemother 2004;48:2787-92.
doi: 10.1128/AAC.48.8.2787-2792.2004
Taqueti VR, Di Carli MF. radionuclide myocardial perfusion imaging for the evaluation of patients with known or suspected coronary artery disease in the era of multimodality cardiovascular imaging. Prog Cardiovasc Dis 2015;57:644-53.
doi: 10.1016/j.pcad.2015.03.004
Naya M, Tamaki N, Tsutsui H. Coronary flow reserve estimated by positron emission tomography to diagnose significant coronary artery disease and predict cardiac events. Circ J 2015;79:15-23.
doi: 10.1253/circj.CJ-14-1060
Zampella E, Acampa W, Assante R, Nappi C, Gaudieri V, Mainolfi CG, et al. Combined evaluation of regional coronary artery calcium and myocardial perfusion by (82)Rb PET/CT in the identification of obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 2018;45:521-9.
doi: 10.1007/s00259-018-3935-1
Johnson NP, Gould KL, Di Carli MF, Taqueti VR. Invasive FFR and noninvasive CFR in the evaluation of ischemia: what is the future? J Am Coll Cardiol 2016;67:2772-88.
doi: 10.1016/j.jacc.2016.03.584
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomized controlled trials. BMJ 2011;343:4002.
doi: 10.1136/bmj.d4002
Sterne JAC, Harbord RM. Funnel plots in meta-analysis. Stata J 2004;4:127-41.
doi: 10.1177/1536867X0400400204
Terrin N, Schmid CH, Lau J. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J Clin Epidemiol 2005;58:894-900.
doi: 10.1016/j.jclinepi.2005.01.006
Gould KL, Johnson NP, Roby AE, Nguyen T, Kirkeeide R, Haynie M, Lai D, Zhu H, et al. Regional, artery-specific thresholds of quantitative myocardial perfusion by PET associated with reduced myocardial infarction and death after revascularization in stable coronary artery disease. J Nucl Med 2019;60:410-7.
doi: 10.2967/jnumed.118.211953