Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease?

J Nucl Cardiol. 2012 Aug;19(4):670-80. doi: 10.1007/s12350-011-9506-5. Epub 2012 Mar 14.


Background: Relative myocardial perfusion imaging (MPI) is the standard imaging approach for the diagnosis and prognostic work-up of coronary artery disease (CAD). However, this technique may underestimate the extent of disease in patients with 3-vessel CAD. Positron emission tomography (PET) is also able to quantify myocardial blood flow. Rubidium-82 ((82)Rb) is a valid PET tracer alternative in centers that lack a cyclotron. The aim of this study was to assess whether assessment of myocardial flow reserve (MFR) measured with (82)Rb PET is an independent predictor of severe obstructive 3-vessel CAD.

Methods: We enrolled a cohort of 120 consecutive patients referred to a dipyridamole (82)Rb PET MPI for evaluation of ischemia neither with prior coronary artery bypass graft nor with recent percutaneous coronary intervention that also underwent coronary angiogram within 6 months of the PET study. Patients with and without 3-vessel CAD were compared.

Results: Among patients with severe 3-vessel CAD, MFR was globally reduced (<2) in 88% (22/25). On the adjusted logistic Cox model, MFR was an independent predictor of 3-vessel CAD [.5 unit decrease, HR: 2.1, 95% CI (1.2-3.8); P = .015]. The incremental value of (82)Rb MFR over the SSS was also shown by comparing the adjusted SSS models with and without (82)Rb MFR (P = .005).

Conclusion: (82)Rb MFR is an independent predictor of 3-vessel CAD and provided added value to relative MPI. Clinical integration of this approach should be considered to enhance detection and risk assessment of patients with known or suspected CAD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiology / methods
  • Cohort Studies
  • Coronary Angiography / methods
  • Coronary Artery Bypass / methods
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / physiopathology*
  • Electrocardiography / methods
  • Female
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Male
  • Middle Aged
  • Myocardial Ischemia / pathology
  • Myocardium / pathology
  • Positron-Emission Tomography / methods*
  • Prognosis
  • Proportional Hazards Models
  • Reproducibility of Results
  • Rubidium Radioisotopes*
  • Time Factors


  • Rubidium Radioisotopes