Abstract
Myocardial flow reserve, derived from quantitative measurements of myocardial blood flow during positron emission tomography imaging, provides prognostic information in patients with coronary artery disease but it is not known if this also applies to cancer patients with competing risk for mortality. Methods: To determine the prognostic value of myocardial flow reserve (MFR) in patients with cancer, we designed a retrospective cohort study comprising 221 patients with known or suspected coronary artery disease (median age: 71 years, range: 41–92 years), enrolled between 6/2009 and 1/2011. The majority of patients were referred for perioperative risk assessment. Patients underwent measurement of myocardial blood flow at rest and during pharmacologic stress, using quantitative 82Rb positron emission tomography imaging. Patients were divided into early-stage vs. advanced-stage cancer groups based on cancer histopathology and clinical state and were further stratified by myocardial perfusion summed stress score, summed difference score, and calculated MFR. Overall survival was assessed using the Kaplan-Meier estimator and Cox proportional hazard regression helped identify independent predictors for overall survival. Results: During a follow-up period of 85.6 months, 120 deaths occurred. MFR, summed difference score, and cancer stage were significantly associated with overall survival. In the age-adjusted Cox hazard multivariable analysis, MFR and cancer stage remained independent prognostic factors. MFR combined with cancer stage provided enhanced overall survival discrimination. The groups had significantly different outcomes (p<0.001), with five-year overall survival of 88% (MFR≥1.97 and early-stage), 53% (MFR<1.97 and early-stage), 33% (MFR≥1.97 and advanced-stage), and 13% (MFR <1.97 and advanced-stage), respectively. Conclusion: Independent of cancer stage, myocardial flow reserve derived from quantitative positron emission tomography was found to be prognostic of overall survival in our cohort of cancer patients with known or suspected coronary artery disease. Combining these two parameters provided enhanced discrimination of overall survival, suggesting that myocardial flow reserve improves risk stratification and may serve as a treatment target to increase survival in cancer patients.
- Cardiology (clinical)
- PET/CT
- Cancer
- Myocardial flow reserve
- Quantitative myocardial perfusion imaging
- Rubidium-PET
- Survival
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