Benjamin J W Chow1, Sharmila Dorbala2, Marcelo F Di Carli2, Michael E Merhige3, Brent A Williams4, Emir Veledar5, James K Min6, Michael J Pencina7, Yeung Yam8, Li Chen9, Sai Priya Anand8, Terrence D Ruddy10, Daniel S Berman11, Leslee J Shaw5, Rob S Beanlands8. 1. Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: bchow@ottawaheart.ca. 2. Division of Cardiovascular Medicine and Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 3. Departments of Cardiology, Internal Medicine, and Nuclear Medicine, Niagara Falls Memorial Medical Center, Buffalo, New York. 4. Department of Center for Health Research, Geisinger Medical Center, Danville, Pennsylvania. 5. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 6. Department of Radiology and Department of Imaging, Weill Cornell Medical College, New York, New York. 7. Department of Biostatistics, Boston University Biostatistics and Harvard Clinical Research Institute, Boston, Massachusetts. 8. Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 9. Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. 10. Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada. 11. Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
OBJECTIVES: This study sought to determine and compare the prognostic and incremental value of positron emission tomography (PET) in normal, overweight, and obese patients. BACKGROUND: Cardiac rubidium 82 (Rb-82) PET is increasingly being used for myocardial perfusion imaging (MPI). A strength of PET is its accurate attenuation correction, thereby potentially improving its diagnostic accuracy in obese patients. The prognostic value of PET in obese patients has not been well studied. METHODS: A total of 7,061 patients who had undergone Rb-82 PET MPI were entered into a multicenter observational registry. All patients underwent pharmacologic Rb-82 PET and were followed for cardiac death and all-cause mortality. Based on body mass index (BMI), patients were categorized as normal (<25 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or obese (≥30 kg/m(2)). Using a 17-segment model and 5-point scoring system, the percentage of abnormal myocardium was calculated for stress and rest patients categorized as normal (0%), mild (0.1% to 9.9%), moderate (10% to 19.9%), and severe (≥20%). RESULTS: A total of 6,037 patients were followed for cardiac death (median: 2.2 years) and the mean BMI was 30.5 ± 7.4 kg/m(2). A total of 169 cardiac deaths were observed. PET MPI demonstrated independent and incremental prognostic value over BMI. Normal PET MPI conferred an excellent prognosis with very low annual cardiac death rates in normal (0.38%), overweight (0.43%), and obese (0.15%) patients. As well, both moderately and severe obese patients with a normal PET MPI had excellent prognosis (0.20% and 0.10%, respectively). The net reclassification improvement of PET was 0.46 (95% confidence interval [CI]: 0.31 to 0.61), and appeared similar in the moderately and severe obese patients which were 0.44 (95% CI: 0.12 to 0.76) and 0.63 (95% CI: 0.27 to 0.98), respectively. CONCLUSIONS: Rb-82 PET has incremental prognostic value in all patients irrespective of BMI. In the obese population, where other modalities may have reduced diagnostic accuracy, cardiac PET appears to be a promising noninvasive modality with prognostic value.
OBJECTIVES: This study sought to determine and compare the prognostic and incremental value of positron emission tomography (PET) in normal, overweight, and obesepatients. BACKGROUND: Cardiac rubidium 82 (Rb-82) PET is increasingly being used for myocardial perfusion imaging (MPI). A strength of PET is its accurate attenuation correction, thereby potentially improving its diagnostic accuracy in obesepatients. The prognostic value of PET in obesepatients has not been well studied. METHODS: A total of 7,061 patients who had undergone Rb-82 PET MPI were entered into a multicenter observational registry. All patients underwent pharmacologic Rb-82 PET and were followed for cardiac death and all-cause mortality. Based on body mass index (BMI), patients were categorized as normal (<25 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or obese (≥30 kg/m(2)). Using a 17-segment model and 5-point scoring system, the percentage of abnormal myocardium was calculated for stress and rest patients categorized as normal (0%), mild (0.1% to 9.9%), moderate (10% to 19.9%), and severe (≥20%). RESULTS: A total of 6,037 patients were followed for cardiac death (median: 2.2 years) and the mean BMI was 30.5 ± 7.4 kg/m(2). A total of 169 cardiac deaths were observed. PET MPI demonstrated independent and incremental prognostic value over BMI. Normal PET MPI conferred an excellent prognosis with very low annual cardiac death rates in normal (0.38%), overweight (0.43%), and obese (0.15%) patients. As well, both moderately and severe obesepatients with a normal PET MPI had excellent prognosis (0.20% and 0.10%, respectively). The net reclassification improvement of PET was 0.46 (95% confidence interval [CI]: 0.31 to 0.61), and appeared similar in the moderately and severe obesepatients which were 0.44 (95% CI: 0.12 to 0.76) and 0.63 (95% CI: 0.27 to 0.98), respectively. CONCLUSIONS:Rb-82 PET has incremental prognostic value in all patients irrespective of BMI. In the obese population, where other modalities may have reduced diagnostic accuracy, cardiac PET appears to be a promising noninvasive modality with prognostic value.
Authors: Navkaranbir S Bajaj; Michael T Osborne; Ankur Gupta; Ali Tavakkoli; Paco E Bravo; Tomas Vita; Courtney F Bibbo; Jon Hainer; Sharmila Dorbala; Ron Blankstein; Deepak L Bhatt; Marcelo F Di Carli; Viviany R Taqueti Journal: J Am Coll Cardiol Date: 2018-08-14 Impact factor: 24.094
Authors: David T Harnett; Samir Hazra; Ronnen Maze; Brian A Mc Ardle; Ali Alenazy; Trevor Simard; Ellen Henry; Girish Dwivedi; Christopher Glover; Robert A deKemp; Ross A Davies; Terrence D Ruddy; Benjamin J W Chow; Rob S Beanlands; Benjamin Hibbert Journal: J Nucl Cardiol Date: 2017-03-29 Impact factor: 5.952
Authors: Paul K R Dasari; Judson P Jones; Michael E Casey; Yuanyuan Liang; Vasken Dilsizian; Mark F Smith Journal: J Nucl Cardiol Date: 2018-06-15 Impact factor: 5.952