University of Oulu

Harjulahti, E., Maaniitty, T., Nammas, W. et al. Global and segmental absolute stress myocardial blood flow in prediction of cardiac events: [¹⁵O] water positron emission tomography study. Eur J Nucl Med Mol Imaging 48, 1434–1444 (2021).

Global and segmental absolute stress myocardial blood flow in prediction of cardiac events : [¹⁵O] water positron emission tomography study

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Author: Harjulahti, Esa1; Maaniitty, Teemu1; Nammas, Wail1,2;
Organizations: 1Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520, Turku, Finland
2Heart Center, Turku University Hospital, Turku, Finland
3Department of Surgery, University of Turku, Turku, Finland
4Department of Surgery, University of Oulu, Oulu, Finland
5Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Springer Nature, 2021
Publish Date: 2021-06-30


Purpose: We evaluated the value of reduced global and segmental absolute stress myocardial blood flow (sMBF) quantified by [¹⁵O] water positron emission tomography (PET) for predicting cardiac events in patients with suspected obstructive coronary artery disease (CAD).

Methods: Global and segmental sMBF during adenosine stress were retrospectively quantified in 530 symptomatic patients who underwent [¹⁵O] water PET for evaluation of coronary stenosis detected by coronary computed tomography angiography.

Results: Cardiovascular death, myocardial infarction, or unstable angina occurred in 28 (5.3%) patients at a 4-year follow-up. Reduced global sMBF was associated with events (area under the receiver operating characteristic curve 0.622, 95% confidence interval (95% CI) 0.538–0.707, p = 0.006). Reduced global sMBF (< 2.2 ml/g/min) was found in 22.8%, preserved global sMBF despite segmentally reduced sMBF in 35.3%, and normal sMBF in 41.9% of patients. Compared with normal sMBF, reduced global sMBF was associated with the highest risk of events (adjusted hazard ratio (HR) 6.970, 95% CI 2.271–21.396, p = 0.001), whereas segmentally reduced sMBF combined with preserved global MBF predicted an intermediate risk (adjusted HR 3.251, 95% CI 1.030–10.257, p = 0.044). The addition of global or segmental reduction of sMBF to clinical risk factors improved risk prediction (net reclassification index 0.498, 95% CI 0.118–0.879, p = 0.010, and 0.583, 95% CI 0.203–0.963, p = 0.002, respectively).

Conclusion: In symptomatic patients evaluated for suspected obstructive CAD, reduced global sMBF by [¹⁵O] water PET identifies those at the highest risk of adverse cardiac events, whereas segmental reduction of sMBF with preserved global sMBF is associated with an intermediate event risk.

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Series: European journal of nuclear medicine and molecular imaging
ISSN: 1619-7070
ISSN-E: 1619-7089
ISSN-L: 1619-7070
Volume: 48
Issue: 5
Pages: 1434 - 1444
DOI: 10.1007/s00259-020-05093-2
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: Open access funding provided by University of Turku (UTU) including Turku University Central Hospital. The study was financially supported by grants from the Finnish Foundation for Cardiovascular Research and State Research Funding of Turku University Hospital.
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