PURPOSE: Evidence to date on the unique female determinants of cardiovascular risk is inadequate. Positron Emission Tomography (PET) is considered to have the highest accuracy for the assessment of myocardial perfusion in patients with suspected coronary artery disease (CAD), but its long-term prognostic accuracy in women has not been established. METHODS: A total of 619 consecutive patients (138 women, mean age 60.0 ± 11.8 years) underwent clinically indicated 13N-ammonia PET at our institution and were followed up (median 5.7 years) for major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for any cardiac reason and late revascularization. RESULTS: During follow-up, 271 patients had at least one cardiac event, including 64 cardiac deaths and 33 nonfatal myocardial infarctions. In both women and men, abnormal myocardial perfusion was associated with reduced event-free survival (log rank p < 0.001). In women, abnormal myocardial perfusion was associated with a higher risk of a worse outcome than in men (adjusted HR 4.1, 95% CI 1.8-9.0 in women; HR 2.4, 95% CI 1.5-3.8 in men; pinteraction < 0.001). In contrast, abnormal coronary flow reserve (CFR) was a significant predictor of 10-year MACE in men (p = 0.006) but not in women (p = NS). Accordingly, an interaction term of sex and abnormal myocardial perfusion or CFR was significant (p < 0.001). CONCLUSION: While perfusion findings in 13N-ammonia PET provide effective risk stratification in women and men, CFR adds incremental prognostic value for long-term cardiac outcomes only in men. Refined strategies in noninvasive imaging are needed in women to improve CAD risk prediction.
PURPOSE: Evidence to date on the unique female determinants of cardiovascular risk is inadequate. Positron Emission Tomography (PET) is considered to have the highest accuracy for the assessment of myocardial perfusion in patients with suspected coronary artery disease (CAD), but its long-term prognostic accuracy in women has not been established. METHODS: A total of 619 consecutive patients (138 women, mean age 60.0 ± 11.8 years) underwent clinically indicated 13N-ammonia PET at our institution and were followed up (median 5.7 years) for major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for any cardiac reason and late revascularization. RESULTS: During follow-up, 271 patients had at least one cardiac event, including 64 cardiac deaths and 33 nonfatal myocardial infarctions. In both women and men, abnormal myocardial perfusion was associated with reduced event-free survival (log rank p < 0.001). In women, abnormal myocardial perfusion was associated with a higher risk of a worse outcome than in men (adjusted HR 4.1, 95% CI 1.8-9.0 in women; HR 2.4, 95% CI 1.5-3.8 in men; pinteraction < 0.001). In contrast, abnormal coronary flow reserve (CFR) was a significant predictor of 10-year MACE in men (p = 0.006) but not in women (p = NS). Accordingly, an interaction term of sex and abnormal myocardial perfusion or CFR was significant (p < 0.001). CONCLUSION: While perfusion findings in 13N-ammonia PET provide effective risk stratification in women and men, CFR adds incremental prognostic value for long-term cardiac outcomes only in men. Refined strategies in noninvasive imaging are needed in women to improve CAD risk prediction.
Entities:
Keywords:
13N-Ammonia PET; Coronary artery disease; Women
Authors: Carl J Pepine; Keith C Ferdinand; Leslee J Shaw; Kelly Ann Light-McGroary; Rashmee U Shah; Martha Gulati; Claire Duvernoy; Mary Norine Walsh; C Noel Bairey Merz Journal: J Am Coll Cardiol Date: 2015-10-27 Impact factor: 24.094
Authors: Areum Kim; Shekhar H Deo; Lauro C Vianna; George M Balanos; Doreen Hartwich; James P Fisher; Paul J Fadel Journal: Am J Physiol Heart Circ Physiol Date: 2011-09-30 Impact factor: 4.733
Authors: Danilo Neglia; Daniele Rovai; Chiara Caselli; Mikko Pietila; Anna Teresinska; Santiago Aguadé-Bruix; Maria Nazarena Pizzi; Giancarlo Todiere; Alessia Gimelli; Stephen Schroeder; Tanja Drosch; Rosa Poddighe; Giancarlo Casolo; Constantinos Anagnostopoulos; Francesca Pugliese; Francois Rouzet; Dominique Le Guludec; Francesco Cappelli; Serafina Valente; Gian Franco Gensini; Camilla Zawaideh; Selene Capitanio; Gianmario Sambuceti; Fabio Marsico; Pasquale Perrone Filardi; Covadonga Fernández-Golfín; Luis M Rincón; Frank P Graner; Michiel A de Graaf; Michael Fiechter; Julia Stehli; Oliver Gaemperli; Eliana Reyes; Sandy Nkomo; Maija Mäki; Valentina Lorenzoni; Giuseppe Turchetti; Clara Carpeggiani; Martina Marinelli; Stefano Puzzuoli; Maurizio Mangione; Paolo Marcheschi; Fabio Mariani; Daniela Giannessi; Stephan Nekolla; Massimo Lombardi; Rosa Sicari; Arthur J H A Scholte; José L Zamorano; Philipp A Kaufmann; S Richard Underwood; Juhani Knuuti Journal: Circ Cardiovasc Imaging Date: 2015-03 Impact factor: 7.792
Authors: Timothy M Bateman; Gary V Heller; A Iain McGhie; John D Friedman; James A Case; Jan R Bryngelson; Ginger K Hertenstein; Kelly L Moutray; Kimberly Reid; S James Cullom Journal: J Nucl Cardiol Date: 2006 Jan-Feb Impact factor: 5.952
Authors: Dominik C Benz; Anita P von Dahlen; Wenjie Huang; Michael Messerli; Elia von Felten; Georgios Benetos; Andreas A Giannopoulos; Tobias A Fuchs; Christoph Gräni; Catherine Gebhard; Aju P Pazhenkottil; Oliver Gaemperli; Philipp A Kaufmann; Ronny R Buechel Journal: Eur J Nucl Med Mol Imaging Date: 2019-07-29 Impact factor: 9.236
Authors: Caroline E Gebhard; Monika Marędziak; Angela Portmann; Susan Bengs; Ahmed Haider; Michael Fiechter; Bernhard A Herzog; Michael Messerli; Valerie Treyer; Ken Kudura; Elia von Felten; Dominik C Benz; Tobias A Fuchs; Christoph Gräni; Aju P Pazhenkottil; Ronny R Buechel; Philipp A Kaufmann; Catherine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2019-06-28 Impact factor: 9.236
Authors: Nidaa Mikail; Alexia Rossi; Susan Bengs; Ahmed Haider; Barbara E Stähli; Angela Portmann; Alessio Imperiale; Valerie Treyer; Alexander Meisel; Aju P Pazhenkottil; Michael Messerli; Vera Regitz-Zagrosek; Philipp A Kaufmann; Ronny R Buechel; Cathérine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2022-08-17 Impact factor: 10.057
Authors: Ahmed Haider; Susan Bengs; Monika Maredziak; Michael Messerli; Michael Fiechter; Andreas A Giannopoulos; Valerie Treyer; Moritz Schwyzer; Christel Hermann Kamani; Dimitri Patriki; Elia von Felten; Dominik C Benz; Tobias A Fuchs; Christoph Gräni; Aju P Pazhenkottil; Philipp A Kaufmann; Ronny R Buechel; Catherine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2019-01-16 Impact factor: 9.236
Authors: Michael Fiechter; Andrea Roggo; Ahmed Haider; Susan Bengs; Irene A Burger; Monika Marędziak; Angela Portmann; Valerie Treyer; Anton S Becker; Michael Messerli; Urs J Mühlematter; Ken Kudura; Elia von Felten; Dominik C Benz; Tobias A Fuchs; Christoph Gräni; Aju P Pazhenkottil; Ronny R Buechel; Philipp A Kaufmann; Catherine Gebhard Journal: J Am Heart Assoc Date: 2019-09-30 Impact factor: 5.501
Authors: Mihir A Kelshiker; Henry Seligman; James P Howard; Haseeb Rahman; Michael Foley; Alexandra N Nowbar; Christopher A Rajkumar; Matthew J Shun-Shin; Yousif Ahmad; Sayan Sen; Rasha Al-Lamee; Ricardo Petraco Journal: Eur Heart J Date: 2022-04-19 Impact factor: 35.855
Authors: Simon M Ametamey; Catherine Gebhard; Ahmed Haider; Susan Bengs; Angela Portmann; Alexia Rossi; Hazem Ahmed; Dominik Etter; Geoffrey I Warnock; Nidaa Mikail; Muriel Grämer; Alexander Meisel; Livio Gisler; Caitlin Jie; Claudia Keller; Sebastian Kozerke; Bruno Weber; Roger Schibli; Linjing Mu; Philipp A Kaufmann; Vera Regitz-Zagrosek Journal: Eur J Nucl Med Mol Imaging Date: 2022-01-13 Impact factor: 10.057