Prognostic implications of myocardial perfusion imaging by 82-rubidium positron emission tomography in male and female patients with angina and no perfusion defects

Aims Myocardial perfusion imaging with 82-rubidium positron emission tomography (Rb-82-PET) is increasingly used to assess stable coronary artery disease (CAD). We aimed to evaluate the prognostic value of Rb-82-PET-derived parameters in patients with symptoms suggestive of CAD but no significant reversible or irreversible perfusion defects. Methods and results Among 3726 consecutive patients suspected of stable CAD who underwent Rb-82-PET between January 2018 and August 2020, 2175 had no regional perfusion defects. Among these patients, we studied the association of Rb-82-PET-derived parameters with a composite endpoint of all-cause mortality, hospitalization for unstable angina pectoris, acute myocardial infarction, heart failure, or ischaemic stroke. During a median follow up of 1.7 years (interquartile range 1.1-2.5 years), there were 148 endpoints. Myocardial blood flow (MBF) reserve (MFR), MBF during stress, left ventricular ejection fraction (LVEF), LVEF-reserve, heart rate reserve, and Ca score were associated with adverse outcomes. In multivariable Cox model adjusted for patient and Rb-82-PET characteristics, MFR < 2 (hazard ratio (HR) 1.75, 95% confidence interval (CI) 1.24-2.48), LVEF (HR 1.38 per 10% decrease, 95% CI 1.24-1.54), and LVEF-reserve (HR 1.19 per 5% decrease, 95% CI 1.07-1.31) were significant predictors of endpoints. Results were consistent in subgroups defined by gender, history of ischaemic heart disease, low LVEF, and atrial fibrillation. Conclusion MFR, LVEF, and LVEF-reserve derived from Rb-82-PET provide prognostic information on cardiovascular outcomes in patients with no perfusion defects. This may aid in identifying patients at risk and might provide an opportunity for preventive interventions.