18F-flurpiridaz positron emission tomography segmental and territory myocardial blood flow metrics: incremental value beyond perfusion for coronary artery disease categorization.
18F-flurpiridaz positron emission tomography segmental and territory myocardial blood flow metrics: incremental value beyond perfusion for coronary artery disease categorization.
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18F-氟吡达正电子发射断层扫描节段和区域心肌血流指标：冠状动脉疾病分类的灌注之外的增量价值。
DOI：
10.1093/ehjci/jeab267
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Maddahi,Jamshid
中科院分区：
文献类型：
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作者：
Packard,RenéRSevag;Votaw,JohnR;Cooke,CDavid;VanTrain,KennethF;Garcia,ErnestV;Maddahi,Jamshid
目的：与标准区域法相比，确定正电子发射断层扫描（PET）分段测量18f -氟吡唑心肌血流量（MBF）的可行性和诊断性能，并评估流量指标是否提供了相对灌注定量（PQ）以外的增量诊断价值。方法和结果纳入18f -氟吡达III期试验中所有可评估的药理学应激患者（n= 245），并获得盲法流量指标。对于每个冠状动脉区域，段流量指标被定义为最低的17段压力MBF （SMBF）、心肌血流储备（MFR）或相对血流储备（RFR）值。采用受试者工作特征（ROC）曲线下面积（AUC）对分段和区域MBF指标的诊断性能进行比较。一个多逻辑模型被用来评估流量指标是否提供了除了PQ之外的增量诊断价值。分段流指标的诊断性能优于区域流指标；SMBF AUC = 0.761 vs. 0.737；MFR AUC = 0.699 vs. 0.676；RFR AUC分别= 0.716 vs. 0.635 （P< 0.001）。在单支冠状动脉疾病（CAD）狭窄度≥70%的分类和每位患者分析中也获得了类似的结果。组合分析显示，只有SMBF能显著提高PQ对CAD≥50%狭窄的诊断效果，PQ AUC = 0.730， PQ +段性SMBF AUC = 0.782 (P< 0.01)， PQ +区域SMBF AUC = 0.771 （P< 0.05）。在冠心病≥70%的狭窄患者中，无流量测量联合PQ可提高诊断性能。结论18f -氟吡嗪评价段段MBF指标是可行的，可改善心外膜CAD的血流检测。当与PQ结合时，只有SMBF在中度CAD中提供附加诊断性能。
AimsWe determined the feasibility and diagnostic performance of segmental18F-flurpiridaz myocardial blood flow (MBF) measurement by positron emission tomography (PET) compared with the standard territory method, and assessed whether flow metrics provide incremental diagnostic value beyond relative perfusion quantitation (PQ).Methods and resultsAll evaluable pharmacological stress patients from the Phase III trial of18F-flurpiridaz were included (n= 245) and blinded flow metrics obtained. For each coronary territory, the segmental flow metric was defined as the lowest 17-segment stress MBF (SMBF), myocardial flow reserve (MFR), or relative flow reserve (RFR) value. Diagnostic performances of segmental and territory MBF metrics were compared by receiver operating characteristic (ROC) areas under the curve (AUC). A multiple logistic model was used to evaluate whether flow metrics provided incremental diagnostic value beyond PQ alone. The diagnostic performances of segmental flow metrics were higher than their territory counterparts; SMBF AUC = 0.761 vs. 0.737; MFR AUC = 0.699 vs. 0.676; and RFR AUC = 0.716 vs. 0.635, respectively (P< 0.001 for all). Similar results were obtained for per-vessel coronary artery disease (CAD) ≥70% stenosis categorization and per-patient analyses. Combinatorial analyses revealed that only SMBF significantly improved the diagnostic performance of PQ in CAD ≥50% stenoses, with PQ AUC = 0.730, PQ + segmental SMBF AUC = 0.782 (P< 0.01), and PQ + territory SMBF AUC = 0.771 (P< 0.05). No flow metric improved diagnostic performance when combined with PQ in CAD ≥70% stenoses.ConclusionAssessment of segmental MBF metrics with18F-flurpiridaz is feasible and improves flow-based epicardial CAD detection. When combined with PQ, only SMBF provides additive diagnostic performance in moderate CAD.