Prognostic value of Transient Ischemic Dilation on Rubidium-82 Positron Emission Tomography Myocardial Perfusion Imaging

Krishna K Patel; Phillip Lim; Poghni A Peri-Okonny; Annapoorna Singh; A Iain McGhie; Basera Sabharwal; Vikram Agarwal; Leslee J Shaw; Timothy M Bateman

doi:10.1016/j.nuclcard.2024.102084

Prognostic value of Transient Ischemic Dilation on Rubidium-82 Positron Emission Tomography Myocardial Perfusion Imaging

J Nucl Cardiol. 2024 Nov 16:102084. doi: 10.1016/j.nuclcard.2024.102084. Online ahead of print.

Authors

Krishna K Patel¹, Phillip Lim², Poghni A Peri-Okonny³, Annapoorna Singh⁴, A Iain McGhie⁴, Basera Sabharwal², Vikram Agarwal², Leslee J Shaw², Timothy M Bateman⁴

Affiliations

¹ Department of Medicine (Cardiology), Mount Sinai Fuster Hear Hospital, New York, NY; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: [email protected].
² Department of Medicine (Cardiology), Mount Sinai Fuster Hear Hospital, New York, NY.
³ Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, CT.
⁴ Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.

PMID: 39557333
DOI: 10.1016/j.nuclcard.2024.102084

Abstract

Rationale: Transient ischemic dilation (TID) of the left ventricular (LV) cavity is considered a high-risk marker in patients with abnormal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Stress image acquisition in Rubidium-82 (⁸²Rb) PET occurs at peak stress compared to 30-60 minutes post stress with SPECT. We aimed to evaluate the prognostic value of TID among patients undergoing ⁸²Rb PET MPI.

Methods: A total of 9878 consecutive patients with LVEF ≥40% undergoing rest/pharmacologic stress ⁸²Rb PET MPI from 2010-2016 were followed for a median of 3.2 years. The primary clinical outcome of cardiac death was assessed after adjusting for pre-test risk, known coronary artery disease (CAD), rest left ventricular ejection fraction (LVEF), summed stress score (SSS), LVEF reserve (LVEF-R), myocardial blood flow reserve (MBFR) and early (90-day) revascularization. Pre-specified interactions between TID ratio and SSSwere included to assess potential differences in the prognostic value of TID in patients based on perfusion.

Results: Mean age of the cohort was 69.0 (11.7) years, 56.1% female, 49.8% with known CAD, 27.9% with abnormal perfusion (SSS>0).There were 451 cardiac deaths. Higher TID ratio was associated with a significantly higher risk of cardiac death, even after accounting for LVEF-R and MBFR (HR per 0.1 unit increase =1.25 (1.11, 1.41), p<0.001). This was seen both among patients with normal (HR for TID per 0.1 unit increase= 1.24 (95% CI: 1.01, 1.52), p=0.04) and abnormal (HR for TID per 0.1 unit increase= 1.14 (95% CI: 1.02, 1.28), p=0.03) perfusion.

Conclusion: TID on rest/stress ⁸²RbPET MPI offers independent prognostic value in patients with both normal and abnormal perfusion beyond other risk markers, among patients with LVEF >40%.