Prognostic value of positron emission tomography derived myocardial flow reserve: A systematic review and meta-analysis

Ahmed Ibrahim Ahmed; Jean Michel Saad; Fares Alahdab; Yushui Han; Malek Nayfeh; Moath Said Alfawara; Mahmoud Al-Rifai; Mouaz Al-Mallah

doi:10.1016/j.atherosclerosis.2023.117280

Prognostic value of positron emission tomography derived myocardial flow reserve: A systematic review and meta-analysis

Atherosclerosis. 2023 Oct:382:117280. doi: 10.1016/j.atherosclerosis.2023.117280. Epub 2023 Sep 13.

Authors

Ahmed Ibrahim Ahmed¹, Jean Michel Saad², Fares Alahdab², Yushui Han², Malek Nayfeh², Moath Said Alfawara², Mahmoud Al-Rifai², Mouaz Al-Mallah³

Affiliations

¹ Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Yale School of Medicine, New Haven, CT, USA.
² Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
³ Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA. Electronic address: mal-mallah@houstonmethodist.org.

PMID: 37742396
DOI: 10.1016/j.atherosclerosis.2023.117280

Abstract

Background and aims: Positron Emission Tomography (PET)-derived myocardial flow reserve (MFR) has been shown to have a role in the diagnosis and prognosis of patients with coronary artery disease (CAD). We performed a systematic review and meta-analysis to summarize the body of literature and synthesize the evidence on the prognostic role of PET-derived MFR in patients with known or suspected CAD.

Methods: A comprehensive literature search of the Medline database from its inception to August 2023, in humans, in any language, was conducted for clinical studies examining the prognostic value of PET imaging in patients of any age, sex, and CAD status. Systematic screening and data extraction of the identified studies were followed by quantitative meta-analysis of PET-MFR's role in predicting adverse clinical events using random effect model. Studies were appraised using the modified Newcastle-Ottawa tool.

Results: A total of 21 studies assessing the prognostic role of PET derived MFR in 46,815 patients with known and/or suspected CAD were included (mean (SD) age 66 (4) years, 48% women). The mean follow-up duration was 36 months (range 10-96). Cardiovascular risk factors were prevalent (73% hypertension, 35% diabetes and 67% dyslipidemia). The definition of the composite outcome varied between studies, with various combinations of mortality, non-fatal myocardial infarction, hospitalization, and coronary revascularization. Pooled impaired MFR was significantly associated with an increased risk of adverse outcomes (RR = 2.94, 95% CI 2.42-3.56, p < 0.001). Results were similar in a subgroup of patients with suspected CAD.

Conclusions: The available body of evidence shows that impaired PET-derived MFR measured using different tracers and PET systems is strongly associated with an increased risk of adverse cardiovascular events. Limitations of this review include observational nature of studies, marked heterogeneity in patient populations, inconsistency in thresholds to define abnormal MFR, and differing components for the composite outcome.

Keywords: Coronary artery disease; Positron emission tomography; Prognosis.

Publication types

Review