Predicting revascularization using 15O-H2O PET myocardial perfusion imaging - impact of atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial perfusion imaging (MPI) by 15O-H2O positron emission tomography (PET) has excellent diagnostic accuracy for detecting significant coronary stenoses and consequently revascularization in patients with angina no previous artery disease (CAD). However, arrhythmias such as atrial fibrillation (AF) are thought to reduce myocardial globally thresholds indicating ischemic CAD therefore likely lower AF. Purpose To determine the ability PET MPI predict subsequent known AF angina. Methods We prospectively included 330 persistent or paroxysmal referred rest/stress prior possible angiography revascularization. 55% had previously documented (181 149 CAD), 41% at time (136 194 sinus rhythm (SR)). Thus, were divided into four groups (SR-noCAD, AF-noCAD, SR-CAD, AF-CAD) independent impact on blood flow (MBF). Primary outcome parameters hyperemic MBF within 3 months MPI. Results As expected, was significantly affected presence both [MBF (ml/g/min): 2.77 +/- 0.93 (SR-noCAD) vs. 2.10 (AF-noCAD) 2.22 (SR-CAD) 1.80 0.74 (AF-CAD), ANOVA p<0.001]. In total, 37 (50 vessels) subsequently revascularized. ROC-analysis vessel specific yielded following optimal cut-offs (ml/g/min) early revascularization: SR-noCAD: 2.03 (AUC 0.95, p<0.001); AF-noCAD: 1.16 0.79, SR-CAD: 1.45 0.77, AF-CAD: 1.28 0.88, p<0.001). Conclusion Hyperemic approximately 20 % regardless status. Despite this, overall high this single centre setup, although and/or decreases moderately.