Abstract
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Introduction: Measurement of global flow reserve is primal advantage for cardiac PET. Myocardial strain has emerged as a promising tool to detect subtle wall dysfunction. We aimed to evaluate the prognostic significance of combined analysis of myocardial flow reserve and strain using a dedicated PETMR system.
Methods: Fifty-nine patients (age 65±14, male 41) who underwent rest-stress ammonia PETMR were enrolled. Global myocardial flow reserve (MFR), cardiac function (left ventricular ejection fraction, LVEF), and summed stress score (SSS) were routinely generated. Global left ventricular longitudinal strain (GLS) was obtained from stress cine image using wall motion tracking technique (Medoviso Inc.). Major adverse cardiovascular event (MACE) was defined as the composite of cardiac death, myocardial infarction, late revascularization, unplanned hospitalization due to of worsening heart failure.
Results: GLS showed strong inverse correlation with stress LVEF, while its correlation was weak with MFR and SSS (r=-0.8, -0.26, and 0.3; p=0.001, 0.004, and 0.04, respectively). In follow up interval of 818±503 days, 18 events (cardiac death 3, late revascularization 15) occurred. Kaplan-Meier curve analysis showed that patients with MFR and GLS worse than the median value (1.79 and -13.7) had significantly higher rate of MACE (hazard ratio [HR], 95% confidence interval [95%CI]: HR 4.9, 95%CI 1.9-12.6, p=0.001; HR 3.2, 95%CI 1.2-8.7, p=0.026, respectively). After dividing into 4 groups above or below median MFR and GLS values, the group with low MFR and worse GLS showed the highest incidence of MACE (HR 5.3, 95%CI: 1.30-21.9, p=0.009).
Conclusions: Simultaneous analysis of global myocardial flow reserve and strain obtained from clinical PETMR may have incremental value for predicting adverse outcomes.
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