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Value of Vasodilator Left Ventricular Ejection Fraction Reserve in Evaluating the Magnitude of Myocardium at Risk and the Extent of Angiographic Coronary Artery Disease: A ⁸²Rb PET/CT Study

¹ Divisions of Nuclear Medicine and Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and ² Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Correspondence: For correspondence or reprints contact: Sharmila Dorbala, MBBS, Division of Nuclear Medicine/PET, Department of Radiology, Brigham and Women's Hospital, 75 Francis St., ASB1, L-1, Boston, MA 02115. E-mail: sdorbala{at}partners.org

Our aim was to determine the value of vasodilator left ventricular ejection fraction (LVEF) reserve (stress ejection fraction – rest ejection fraction) in evaluating the magnitude of myocardium at risk and the anatomic extent of underlying severe coronary artery disease (CAD). Methods: We studied 510 consecutive patients with suspected CAD undergoing gated rest and vasodilator stress ⁸²Rb PET/CT. Patients were categorized as having no perfusion abnormalities, mild, moderate, or severe reversible perfusion defects. In a subgroup of 68 patients with coronary angiography, patients were categorized as having 0-vessel, 1-vessel, 2-vessel, or left main/3-vessel disease. Results: Patients without coronary risk factors who comprised our control group as well as patients with coronary risk factors and normal perfusion demonstrated a high LVEF reserve (7% ± 7% and 5% ± 6%, respectively). The mean LVEF reserve was negative (–0.2% ± 8%) in patients with severe reversible defects and in patients with 3-vessel (–6% ± 8%) and left main (–8% ± 5%) disease. Among the clinical and scintigraphic variables studied, male sex, rest ejection fraction, and increasing magnitude of myocardium at risk predicted a lower LVEF reserve, whereas LVEF reserve was the only independent predictor of left main/3-vessel disease (P = 0.008). An LVEF reserve of more than +5% had a positive predictive value of only 41% but a negative predictive value of 97% for excluding severe left main/3-vessel CAD. Conclusion: During ⁸²Rb PET/CT, LVEF increases with vasodilator stress in patients without significant stress-induced perfusion defects or severe left main/3-vessel CAD. A high LVEF reserve appears to be an excellent tool to exclude left main/3-vessel CAD noninvasively.

Key Words: rest and stress ejection fraction • vasodilator stress • severe coronary artery disease

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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