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Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography: Added value of coronary flow reserve
JACC - Journal of the American College of Cardiology, 07/02/09

Herzog BA et al. – Perfusion findings 13N-ammonia positron emission tomography (PET) and coronary flow reserve (CFR) are strong outcome predictors. CFR allows further risk stratification, suggesting a "warranty" period of 3 yrs if normal CFR is associated with normal perfusion. Conversely, in pts with abnormal perfusion, an impaired CFR has added value for predicting adverse outcomes.

• Study of the predictive value of myocardial perfusion imaging with 13N-ammonia PET and CFR on long-term prognosis in pts with suspected myocardial ischemia
• Perfusion and CFR assessed in 256 pts using 13N-ammonia PET
• Follow-up in 245 (96%) pts
• Exclusion of 16 early revascularized pts
• 229 pts assigned to normal vs abnormal perfusion or normal vs abnormal CFR (<2)

• During follow-up (5.4 ± 2.2 yrs), 78 pts had ≥1 cardiac event, including 29 cardiac deaths
• Abnormal perfusion (126 pts) associated with higher incidence of major adverse cardiac events (MACE) and cardiac death
• In pts with normal perfusion, abnormal CFR independently associated with higher annual event rate over 3 yrs vs normal CFR for MACE (1.4% vs 6.3%) and cardiac death (0.5% vs 3.1%)
• In abnormal perfusion, CFR remained predictive throughout 10-yr follow-up

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