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J Am Coll Cardiol, 2006; 48:1029-1039, doi:10.1016/j.jacc.2006.06.025 (Published online 15 August 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: CARDIAC IMAGING

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

Keiichiro Yoshinaga, MD, Benjamin J.W. Chow, MD, Kathryn Williams, MS, Li Chen, MSc, Robert A. deKemp, PhD, Linda Garrard, RN, BScN, Alexander Lok-Tin Szeto, MD, May Aung, RT, Ross A. Davies, MD, Terrence D. Ruddy, MD and Rob S.B. Beanlands, MD*

Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Manuscript received October 3, 2005; revised manuscript received January 26, 2006, accepted March 7, 2006.

* Reprint requests and correspondence: Dr. Rob S. B. Beanlands, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7. (Email: rbeanlands{at}ottawaheart.ca).

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




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