Coronary Flow Capacity And Survival Prediction After Revascularization: Physiological Basis And Clinical Implications.

Coronary artery disease PET imaging coronary bypass surgery coronary flow reserve myocardial ischemia myocardial perfusion

Journal

European heart journal
ISSN: 1522-9645
Titre abrégé: Eur Heart J
Pays: England
ID NLM: 8006263

Informations de publication

Date de publication:
27 Aug 2023
Historique:
received: 09 07 2023
revised: 20 08 2023
accepted: 21 08 2023
medline: 27 8 2023
pubmed: 27 8 2023
entrez: 27 8 2023
Statut: aheadofprint

Résumé

Coronary Flow Capacity (CFC) associates with an Observed 10-yearsurvival probability for individual patients before and after actual revascularization for comparison to Virtual hypothetical ideal complete revascularization. Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle (%LV) with prospective follow-up to define survival probability per-decade as fraction of 1.0. Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P=0.0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P<0.001), more so after bypass surgery than percutaneous coronary interventions (P<0.001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P=0.00001). Observed CFC=associated survival probability after actual revascularization was lower than Virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P<0.001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P=0.025). Severely reduced CFC and associated Observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between Observed actual and Virtual hypothetical post=revascularization survival probability revealed residual CAD or failed revascularization.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Coronary Flow Capacity (CFC) associates with an Observed 10-yearsurvival probability for individual patients before and after actual revascularization for comparison to Virtual hypothetical ideal complete revascularization.
METHODS METHODS
Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle (%LV) with prospective follow-up to define survival probability per-decade as fraction of 1.0.
RESULTS RESULTS
Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P=0.0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P<0.001), more so after bypass surgery than percutaneous coronary interventions (P<0.001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P=0.00001). Observed CFC=associated survival probability after actual revascularization was lower than Virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P<0.001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P=0.025).
CONCLUSIONS CONCLUSIONS
Severely reduced CFC and associated Observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between Observed actual and Virtual hypothetical post=revascularization survival probability revealed residual CAD or failed revascularization.

Identifiants

DOI: 10.1093/eurheartj/ehad579 PMID: 37634192
pubmed: 37634192
pii: 7251371
doi: 10.1093/eurheartj/ehad579
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Auteurs

K Lance Gould (KL)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.
ORCID: 0000-0003-4019-5941

Nils P Johnson (NP)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.
ORCID: 0000-0002-0897-2301

Amanda E Roby (AE)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Linh Bui (L)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Danai Kitkungvan (D)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Monica B Patel (MB)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Tung Nguyen (T)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Richard Kirkeeide (R)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Mary Haynie (M)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Salman A Arain (SA)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Konstantinos Charitakis (K)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Abhijeet Dhoble (A)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.
ORCID: 0000-0001-8244-274X

Richard Smalling (R)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Angelo Nascimbene (A)

Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Marwan Jumean (M)

Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Sachin Kumar (S)

Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Biswajit Kar (B)

Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Stefano Sdringola (S)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Anthony Estrera (A)

Department of Cardiothoracic Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Hospital, Houston, Texas.

Igor Gregoricm (I)

Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Dejian Lai (D)

University of Texas School of Public Health - Houston, Department of Biostatistics and Data Science, Houston, Texas.

Ruosha Li (R)

University of Texas School of Public Health - Houston, Department of Biostatistics and Data Science, Houston, Texas.

David McPherson (D)

Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Jagat Narula (J)

Weatherhead P.E.T. Center, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas, Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, Texas.

Classifications MeSH