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Research ArticleClinical Investigation

Long-Term Prognostic Value of 82Rb PET/CT–Determined Myocardial Perfusion and Flow Reserve in Cancer Patients

Josef J. Fox, Audrey Mauguen, Kimiteru Ito, Dipti Gupta, Alice Yu, Thomas H. Schindler, H. William Strauss and Heiko Schöder
Journal of Nuclear Medicine May 2023, 64 (5) 791-796; DOI: https://doi.org/10.2967/jnumed.122.264795
Josef J. Fox
1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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Audrey Mauguen
2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York;
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Kimiteru Ito
1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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Dipti Gupta
3Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
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Alice Yu
1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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Thomas H. Schindler
4Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
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H. William Strauss
1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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Heiko Schöder
1Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York;
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  • FIGURE 1.
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    FIGURE 1.

    Flowchart of study patients.

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    FIGURE 2.

    Kaplan–Meier overall survival analysis stratified by MFR (<1.97 versus ≥1.97) and cancer stage (early versus advanced) in the overall cohort (n = 221).

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    TABLE 1.

    Demographics and Characteristics of Study Cohort (n = 221)

    CharacteristicDataCharacteristicData
    Age (y)71 (41–92)Vasodilator
    Age, binary Dipyridamole93 (42.1%)
     <65 y73 (33.0%) Regadenoson128 (57.9%)
     ≥65 y148 (67.0%)Heart rate (rest)70.05 ± 13.15
    SexHeart rate (stress)87.44 ± 16.56 (2*)
     Female97 (43.9%)Rest systolic blood pressure140.60 ± 20.55
     Male124 (56.1%)Stress systolic blood pressure131.53 ± 22.53 (3*)
    Height (cm)168 (132–193)Transient ischemic dilatation ratio1.06 ± 0.15 (1*)
    Weight (kg)79 (36–161)Stress MBF (mg/mL/min)1.93 ± 0.74
    Body mass index27.82 (16.00–68.78)Rest MBF (mg/mL/min)1.01 ± 0.42
    Body mass index, binaryAdjusted rest MBF (mg/mL/min)0.88 ± 0.32
     <30136 (61.5%)MFR2.04 ± 0.74
     ≥3085 (38.5%)Adjusted MFR2.31 ± 0.85
    Stress LVEF (%)71 (18–90) (1*)Morise risk assessment
    Stress LVEF (%), binary1* Low (0–8)8 (3.6%)
     ≥50198 (90.0%) Intermediate (9–15)93 (42.1%)
     <5022 (10.0%) High (>15)120 (54.3%)
    Rest LVEF (%)66 (21–90) (1*)SSS
    Rest LVEF (%), binary1* Normal (0–3)169 (76.5%)
     ≥50194 (88.2%) Mild (4–7)26 (11.8%)
     <5026 (11.8%) Moderate (8–11)8 (3.6%)
    LVEF reserve5 (-22–21) (1*) Severe (≥12)18 (8.1%)
    Abnormal LVEF reserve1*Ischemia (SDS ≥ 3)
     Normal196 (89.1%) Abnormal46 (20.8%)
     Abnormal24 (10.9%) Normal175 (79.2%)
    Hemoglobin (g/dL)12.40 (7.60–16.70) (4*)Coronary calcium (Agatston score)5*
    Hemoglobin, binary4* None/minimal (0–10)47 (21.8%)
     ≥10 g/dL189 (87.1%) Mild (11–100)37 (17.1%)
     <10 g/dL28 (12.9%) Moderate (101–400)46 (21.3%)
    Diabetes Severe (>400)68 (31.5%)
     No143 (64.7%) Stent9 (4.2%)
     Yes78 (35.3%) Coronary artery bypass graft9 (4.2%)
    Dyslipidemia157 (71.0%)eGFR (mL/min/1.73 m2)64 (22–109)
    Hypertension172 (77.8%)eGFR, binary
    Smoker/former smoker159 (71.9%) ≤6096 (43.4%)
    History of CAD82 (37.1%) >60125 (56.6%)
    • ↵* Unknown.

    • LVEF = left ventricular ejection fraction; MBF = myocardial blood flow; eGFR = estimated glomerular filtration rate.

    • Qualitative data are number and percentage; continuous data are median and range or mean ± SD.

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    TABLE 2.

    Factors Contributing to Low MFR (All Patients)

    CharacteristicMFR ≥ 1.97, n = 111MFR < 1.97, n = 110P†
    Stress MBF (mg/mL/min)2.14 (0.85–4.64)1.57 (0.39–3.64)<0.001
    Rest MBF (mg/mL/min)0.81 (0.40–2.25)1.01 (0.48–2.61)<0.001
    Adjusted rest MBF (mg/mL/min)0.77 (0.31–1.40)0.88 (0.39–2.60)<0.001
    Heart rate (stress)87 (52–126) (2*)84 (51–141)0.33
    Heart rate (rest)66 (44–102)71 (42–112)0.006
    Ejection fraction (stress, %)73 (40–90)67 (18–90) (1*)0.002
    Ejection fraction (rest, %)67 (27–90)64 (21–86) (1*)0.084
    SSS0.0 (0.0–21.0)1.0 (0.0–40.0)0.003
    SDS0.0 (0.0–9.0)0.0 (0.0–26.0)0.021
    Hemoglobin (g/dL)12.85 (7.60–16.70) (1*)11.80 (7.60–15.60) (3*)<0.001
    Body mass index28 (19–51)27 (16–69)0.26
    Vasodilator0.64
     Dipyridamole45 (41%)48 (44%)
     Regadenoson66 (59%)62 (56%)
    History of CAD29 (26%)53 (48%)<0.001
    Coronary calcium (Agatston score)(2*)(3*)<0.001
     None/minimal (0–10)32 (29%)15 (14%)
     Mild (11–100)25 (23%)12 (11%)
     Moderate (101–400)25 (23%)21 (20%)
     Severe (>400)25 (23%)43 (40%)
     Stent1 (1%)8 (7%)
     Coronary artery bypass graft1 (1%)8 (7%)
    Age (y)67 (44–92)75 (41–90)<0.001
    • ↵* Unknown.

    • ↵† Welch 2-sample t test, Wilcoxon rank sum test, Pearson χ2 test; Fisher exact test.

    • MBF = myocardial blood flow.

    • Qualitative data are number and percentage; continuous data are median and range.

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Journal of Nuclear Medicine: 64 (5)
Journal of Nuclear Medicine
Vol. 64, Issue 5
May 1, 2023
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Long-Term Prognostic Value of 82Rb PET/CT–Determined Myocardial Perfusion and Flow Reserve in Cancer Patients
Josef J. Fox, Audrey Mauguen, Kimiteru Ito, Dipti Gupta, Alice Yu, Thomas H. Schindler, H. William Strauss, Heiko Schöder
Journal of Nuclear Medicine May 2023, 64 (5) 791-796; DOI: 10.2967/jnumed.122.264795

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Long-Term Prognostic Value of 82Rb PET/CT–Determined Myocardial Perfusion and Flow Reserve in Cancer Patients
Josef J. Fox, Audrey Mauguen, Kimiteru Ito, Dipti Gupta, Alice Yu, Thomas H. Schindler, H. William Strauss, Heiko Schöder
Journal of Nuclear Medicine May 2023, 64 (5) 791-796; DOI: 10.2967/jnumed.122.264795
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