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Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We performed a meta-meta-analysis to evaluate the prognostic value of coronary flow reserve (CFR) assessed by cardiac positron emission tomography (PET) imaging in patients with suspected or known coronary artery disease (CAD).

Methods

Studies published until April 2019 were identified by database search. We included studies if they evaluated CFR by PET providing data on adjusted hazard ratio (HR) for the occurrence of adverse events. Annualized event rates were calculated and the incidence rate ratios with 95% confidence interval (CI) were estimated to compare patients with impaired and preserved CFR.

Results

We identified 13 eligible articles including 11,867 patients with a follow-up ranging from 0.6 to 7.1 years. The HR for the occurrence of major adverse cardiac events (MACE) was reported in 11 studies and pooled HR was 1.93 (95% CI 1.65-2.27). The HR for the occurrence of hard events was reported in 5 studies and pooled HR was 3.11 (95% CI 1.88-5.14). Six studies reported data useful to calculate separately the incidence rate of MACE in patients with preserved and impaired CFR and pooled IRR was 2.26 (CI 95% 1.79-2.85). Three studies reported data useful to calculate separately the incidence rate of hard events in patients with preserved and impaired CFR and pooled IRR was 4.12 (CI 95% 3.08-5.51). At meta-regression analysis, we found an association between HR for MACE and gender, diabetes and hypertension, while no significant association was found between HR for hard events and demographic and clinical variables.

Conclusion

In patients with suspected or known CAD, an impaired CFR is associated with adverse cardiovascular events. However, the large heterogeneity in study population underlines the need for further investigations to maximize the prognostic role of CFR.

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Abbreviations

CAD:

Coronary artery disease

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

CFR:

Coronary flow reserve

MBF:

Myocardial blood flow

HR:

Hazard ratio

IRR:

Incidence rate ratio

CI:

Confidence interval

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Disclosure

R Green, V. Cantoni, W. Acampa, R. Assante, E. Zampella, C. Nappi, V. Gaudieri, T. Mannarino, R. Cuocolo, M. Petretta, and A. Cuocolo declare that they have no financial conflict of interest.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

    Roberta Green PhD, Valeria Cantoni PhD, Wanda Acampa MD, PhD, Roberta Assante MD, PhD, Emilia Zampella MD, PhD, Carmela Nappi MD, PhD, Valeria Gaudieri MD, PhD, Teresa Mannarino MD, Renato Cuocolo MD & Alberto Cuocolo MD

  2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

    Wanda Acampa MD, PhD

  3. Department of Translational Medical Sciences, University Federico II, Naples, Italy

    Mario Petretta MD, FAHA

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  1. Roberta Green PhD
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  2. Valeria Cantoni PhD
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  3. Wanda Acampa MD, PhD
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  4. Roberta Assante MD, PhD
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  5. Emilia Zampella MD, PhD
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  7. Valeria Gaudieri MD, PhD
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  11. Alberto Cuocolo MD
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Correspondence to Alberto Cuocolo MD.

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Green, R., Cantoni, V., Acampa, W. et al. Prognostic value of coronary flow reserve in patients with suspected or known coronary artery disease referred to PET myocardial perfusion imaging: A meta-analysis. J. Nucl. Cardiol. 28, 904–918 (2021). https://doi.org/10.1007/s12350-019-02000-7

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