Clinical Research
Cardiac Imaging
What is the Prognostic Value of Myocardial Perfusion Imaging Using Rubidium-82 Positron Emission Tomography?

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Objectives

The objective was to determine the prognostic value of rubidium-82 (82Rb) positron emission tomography (PET) myocardial perfusion imaging (MPI).

Background

82Rb PET MPI accurately diagnoses coronary artery disease (CAD). However, there are limited data evaluating its prognostic value.

Methods

Follow-up (3.1 ± 0.9 years) was obtained in 367 patients who underwent dipyridamole 82Rb PET MPI. Patients were divided into groups based on their summed stress score (SSS): group I, normal (<4); group II, mild (4 to 7); and group III, moderate (8 to 11) to severe (≥12).

Results

There were significant differences among patients in the 3 SSS groups for hard events (cardiac death and myocardial infarction [MI]) (p < 0.001) and total cardiac events (hard events, revascularization and hospitalization) (p < 0.001). The annual hard events rates were 0.4%, 2.3%, and 7.0% in the normal, mild, and moderate-severe groups, respectively. In adjusted survival models, 82Rb PET SSS was the strongest predictor of total cardiac events and a significant predictor of hard events. Among patients referred for PET after 99mTc single-photon emission computed tomography, the annual total event rate was higher with abnormal versus normal SSS on PET (15.2% vs. 1.3%, p < 0.001). In patients with obesity, the annual total event rate was 11.1% with an abnormal scan and 1.5% with a normal scan (p < 0.001).

Conclusions

This study shows that 82Rb PET MPI has significant prognostic value for predicting cardiac events, including death and MI. It also seems to have prognostic value in patients whose diagnosis remains uncertain after single-photon emission computed tomography MPI and in obese patients. The prognostic value of PET MPI may improve the management of cardiac patients.

Abbreviations and Acronyms

BMI
body mass index
CABG
coronary artery bypass grafting
CAD
coronary artery disease
MI
myocardial infarction
MPI
myocardial perfusion imaging
PCI
percutaneous coronary intervention
PET
positron emission tomography
82Rb
rubidium-82
SDS
summed difference score
SPECT
single-photon emission computed tomography
SRS
summed rest score
SSS
summed stress score

Cited by (0)

This study was supported in part by grants from the Canadian Institute for Health Research (Ottawa, Ontario, Canada), Heart & Stroke Foundation of Canada (Ottawa, Ontario, Canada), and the Ontario Research Challenge Fund (Ottawa, Ontario, Canada). Dr. Yoshinaga was supported by the Toronto Dominion Bank Fellowship Program (2003–2004) (Toronto, Ontario, Canada), the International Fellowship Program at the University of Ottawa (2004–2006) (Ottawa, Ontario, Canada) and the International Fellowship Program at Uehara Memorial Foundation, Japan (2004–2005) (Tokyo, Japan). Dr. Beanlands was a Research Scientist supported by the Canadian Institute for Health Research (Ottawa, Ontario, Canada).