Patient factors and outcomes associated with discordance between quantitative and qualitative cardiac PET ischemia information.
Aged
Aged, 80 and over
Disease Progression
Female
Fractional Flow Reserve, Myocardial
Humans
Male
Middle Aged
Myocardial Ischemia
/ diagnostic imaging
Myocardial Perfusion Imaging
/ methods
Positron Emission Tomography Computed Tomography
Prognosis
Radiographic Image Interpretation, Computer-Assisted
/ methods
Retrospective Studies
Rubidium Radioisotopes
/ administration & dosage
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
22
02
2020
accepted:
15
01
2021
entrez:
3
3
2021
pubmed:
4
3
2021
medline:
27
8
2021
Statut:
epublish
Résumé
Cardiac PET can provide quantitative myocardial blood flow (MBF) estimates. The frequency and clinical significance of discordant ischemia information between quantitative and qualitative parameters is unclear. This retrospective, cohort study analyzed 256 Rb-82 stress-rest PET/CT studies. Global MBF and myocardial flow reserve (MFR) were estimated in absolute units for quantitative results and sum-stress and difference scores were used for qualitative results. Four groups of patients were evaluated based on a specific definition of concordant and discordant quantitative and qualitative results. 31% of cases demonstrated discordance. Factors associated with microvascular disease were more common in the groups with abnormal quantitative results, regardless of the qualitative findings. Patients with concordant abnormal results had a significantly increased risk of myocardial infarction, heart failure, percutaneous intervention, and all-cause-mortality at 1 year compared to patients with concordant normal results. In patients with discordant results of abnormal quantitative and normal qualitative findings, there was a higher prevalence of heart failure than in controls (12.5% vs 0%, p = 0.01). Discordance in qualitative and quantitative ischemia measures from PET is common, and further study is needed to clarify its prognostic implications. Moreover, quantitative estimation of MBF and MFR appears to add value to qualitative visual interpretation by supporting qualitative findings when results are concordant. Abnormal quantitative findings, regardless of concordance or discordance with qualitative findings, occurred in patients with risk factors associated with diffuse disease and with increased risk of heart failure admission.
Sections du résumé
BACKGROUND
Cardiac PET can provide quantitative myocardial blood flow (MBF) estimates. The frequency and clinical significance of discordant ischemia information between quantitative and qualitative parameters is unclear.
METHODS
This retrospective, cohort study analyzed 256 Rb-82 stress-rest PET/CT studies. Global MBF and myocardial flow reserve (MFR) were estimated in absolute units for quantitative results and sum-stress and difference scores were used for qualitative results. Four groups of patients were evaluated based on a specific definition of concordant and discordant quantitative and qualitative results.
RESULTS
31% of cases demonstrated discordance. Factors associated with microvascular disease were more common in the groups with abnormal quantitative results, regardless of the qualitative findings. Patients with concordant abnormal results had a significantly increased risk of myocardial infarction, heart failure, percutaneous intervention, and all-cause-mortality at 1 year compared to patients with concordant normal results. In patients with discordant results of abnormal quantitative and normal qualitative findings, there was a higher prevalence of heart failure than in controls (12.5% vs 0%, p = 0.01).
CONCLUSIONS
Discordance in qualitative and quantitative ischemia measures from PET is common, and further study is needed to clarify its prognostic implications. Moreover, quantitative estimation of MBF and MFR appears to add value to qualitative visual interpretation by supporting qualitative findings when results are concordant. Abnormal quantitative findings, regardless of concordance or discordance with qualitative findings, occurred in patients with risk factors associated with diffuse disease and with increased risk of heart failure admission.
Identifiants
pubmed: 33657111
doi: 10.1371/journal.pone.0246149
pii: PONE-D-20-05186
pmc: PMC7928488
doi:
Substances chimiques
Rubidium Radioisotopes
0
Rubidium-82
9K730EL8KU
Types de publication
Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0246149Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL109327
Pays : United States
Organisme : NHLBI NIH HHS
ID : R56 HL109327
Pays : United States
Déclaration de conflit d'intérêts
None of the authors report any conflicts of interest.
Références
J Am Coll Cardiol. 2018 Apr 3;71(13):1444-1456
pubmed: 29598865
Circulation. 1993 Sep;88(3):993-1003
pubmed: 8353927
J Am Coll Cardiol. 2013 Oct 29;62(18):1639-1653
pubmed: 23954338
J Nucl Cardiol. 2012 Aug;19(4):670-80
pubmed: 22415819
Ann Nucl Med. 2000 Oct;14(5):353-60
pubmed: 11108164
Eur Heart J Cardiovasc Imaging. 2013 Dec;14(12):1203-10
pubmed: 23660750
Radiographics. 2011 Sep-Oct;31(5):1239-54
pubmed: 21918042
NCHS Data Brief. 2017 Oct;(289):1-8
pubmed: 29155682
Eur Heart J. 2007 Sep;28(18):2223-30
pubmed: 17604290
Circulation. 2000 Sep 12;102(11):1233-8
pubmed: 10982536
Eur J Nucl Med Mol Imaging. 2005 Dec;32(12):1371-7
pubmed: 16133398
Am J Cardiol. 1974 Jan;33(1):87-94
pubmed: 4808557
JACC Cardiovasc Imaging. 2009 Jul;2(7):846-54
pubmed: 19608135
J Nucl Med. 2018 Feb;59(2):273-293
pubmed: 29242396
Microcirculation. 2017 Jan;24(1):
pubmed: 27976459
Circulation. 1999 Feb 2;99(4):491-7
pubmed: 9927394
Diabetologia. 2016 Feb;59(2):371-8
pubmed: 26526662
MMWR Morb Mortal Wkly Rep. 2018 Jan 19;67(2):53-59
pubmed: 29346338
JACC Cardiovasc Imaging. 2014 Nov;7(11):1119-1127
pubmed: 25306543
Hypertension. 2001 Sep;38(3 Pt 2):581-7
pubmed: 11566935
Circ Cardiovasc Imaging. 2015 May;8(5):
pubmed: 25977304
J Am Coll Cardiol. 2003 Apr 16;41(8):1387-93
pubmed: 12706936
J Nucl Cardiol. 2016 Oct;23(5):1187-1226
pubmed: 27392702
Circ Res. 2000 Nov 10;87(10):840-4
pubmed: 11073878
Eur Heart J Cardiovasc Imaging. 2019 Feb 1;20(2):233-240
pubmed: 29992262
Nat Rev Cardiol. 2015 Jan;12(1):48-62
pubmed: 25311229
J Nucl Med. 2011 May;52(5):726-32
pubmed: 21498538
Eur J Nucl Med Mol Imaging. 2007 Oct;34(10):1683-92
pubmed: 17661031
JACC Cardiovasc Imaging. 2012 Apr;5(4):430-40
pubmed: 22498334
J Hypertens. 2014 Dec;32(12):2465-71; discussion 2471
pubmed: 25188369
Heart. 2007 Mar;93(3):345-9
pubmed: 16940388
Am J Cardiol. 1988 Jun 1;61(15):1338-43
pubmed: 3287885
Curr Cardiol Rep. 2016 Jan;18(1):1
pubmed: 26694723
J Nucl Med. 2009 Feb;50(2):214-9
pubmed: 19164219
J Am Coll Cardiol. 2012 May 8;59(19):1719-28
pubmed: 22554604
Eur Heart J Cardiovasc Imaging. 2015 Aug;16(8):900-9
pubmed: 25719181
J Nucl Cardiol. 2013 Feb;20(1):64-75
pubmed: 23081762
J Am Coll Cardiol. 2006 Sep 5;48(5):1029-39
pubmed: 16949498
JACC Cardiovasc Imaging. 2010 Jun;3(6):623-40
pubmed: 20541718