Added prognostic value of myocardial blood flow quantitation in rubidium-82 positron emission tomography imaging

Eur Heart J Cardiovasc Imaging. 2013 Dec;14(12):1203-10. doi: 10.1093/ehjci/jet068. Epub 2013 May 9.


Aims: We studied the respective added value of the quantitative myocardial blood flow (MBF) and the myocardial flow reserve (MFR) as assessed with (82)Rb positron emission tomography (PET)/CT in predicting major adverse cardiovascular events (MACEs) in patients with suspected myocardial ischaemia.

Methods and results: Myocardial perfusion images were analysed semi-quantitatively (SDS, summed difference score) and quantitatively (MBF, MFR) in 351 patients. Follow-up was completed in 335 patients and annualized MACE (cardiac death, myocardial infarction, revascularization, or hospitalization for congestive heart failure or de novo stable angor) rates were analysed with the Kaplan-Meier method in 318 patients after excluding 17 patients with early revascularizations (<60 days). Independent predictors of MACEs were identified by multivariate analysis. During a median follow-up of 624 days (inter-quartile range 540-697), 35 MACEs occurred. An annualized MACE rate was higher in patients with ischaemia (SDS >2) (n = 105) than those without [14% (95% CI = 9.1-22%) vs. 4.5% (2.7-7.4%), P < 0.0001]. The lowest MFR tertile group (MFR <1.8) had the highest MACE rate [16% (11-25%) vs. 2.9% (1.2-7.0%) and 4.3% (2.1-9.0%), P < 0.0001]. Similarly, the lowest stress MBF tertile group (MBF <1.8 mL/min/g) had the highest MACE rate [14% (9.2-22%) vs. 7.3% (4.2-13%) and 1.8% (0.6-5.5%), P = 0.0005]. Quantitation with stress MBF or MFR had a significant independent prognostic power in addition to semi-quantitative findings. The largest added value was conferred by combining stress MBF to SDS. This holds true even for patients without ischaemia.

Conclusion: Perfusion findings in (82)Rb PET/CT are strong MACE outcome predictors. MBF quantification has an added value allowing further risk stratification in patients with normal and abnormal perfusion images.

Keywords: Coronary artery disease; Major adverse cardiovascular events; Myocardial perfusion imaging; Outcome; Positron emission tomography; Rubidium-82.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Circulation / physiology
  • Disease Progression*
  • Evaluation Studies as Topic
  • Female
  • Humans
  • Image Enhancement
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / diagnostic imaging
  • Myocardial Perfusion Imaging / methods*
  • Positron-Emission Tomography / methods
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Rubidium Radioisotopes*
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Tomography, X-Ray Computed / methods


  • Rubidium Radioisotopes