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Prognostic value of PET myocardial perfusion imaging in obese patients.

Publication ,  Journal Article
Chow, BJW; Dorbala, S; Di Carli, MF; Merhige, ME; Williams, BA; Veledar, E; Min, JK; Pencina, MJ; Yam, Y; Chen, L; Anand, SP; Ruddy, TD ...
Published in: JACC Cardiovasc Imaging
March 2014

OBJECTIVES: This study sought to determine and compare the prognostic and incremental value of positron emission tomography (PET) in normal, overweight, and obese patients. BACKGROUND: Cardiac rubidium 82 (Rb-82) PET is increasingly being used for myocardial perfusion imaging (MPI). A strength of PET is its accurate attenuation correction, thereby potentially improving its diagnostic accuracy in obese patients. The prognostic value of PET in obese patients has not been well studied. METHODS: A total of 7,061 patients who had undergone Rb-82 PET MPI were entered into a multicenter observational registry. All patients underwent pharmacologic Rb-82 PET and were followed for cardiac death and all-cause mortality. Based on body mass index (BMI), patients were categorized as normal (<25 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or obese (≥30 kg/m(2)). Using a 17-segment model and 5-point scoring system, the percentage of abnormal myocardium was calculated for stress and rest patients categorized as normal (0%), mild (0.1% to 9.9%), moderate (10% to 19.9%), and severe (≥20%). RESULTS: A total of 6,037 patients were followed for cardiac death (median: 2.2 years) and the mean BMI was 30.5 ± 7.4 kg/m(2). A total of 169 cardiac deaths were observed. PET MPI demonstrated independent and incremental prognostic value over BMI. Normal PET MPI conferred an excellent prognosis with very low annual cardiac death rates in normal (0.38%), overweight (0.43%), and obese (0.15%) patients. As well, both moderately and severe obese patients with a normal PET MPI had excellent prognosis (0.20% and 0.10%, respectively). The net reclassification improvement of PET was 0.46 (95% confidence interval [CI]: 0.31 to 0.61), and appeared similar in the moderately and severe obese patients which were 0.44 (95% CI: 0.12 to 0.76) and 0.63 (95% CI: 0.27 to 0.98), respectively. CONCLUSIONS: Rb-82 PET has incremental prognostic value in all patients irrespective of BMI. In the obese population, where other modalities may have reduced diagnostic accuracy, cardiac PET appears to be a promising noninvasive modality with prognostic value.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

March 2014

Volume

7

Issue

3

Start / End Page

278 / 287

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Severity of Illness Index
  • Rubidium Radioisotopes
  • Risk Factors
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Obesity
 

Citation

APA
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Chow, B. J. W., Dorbala, S., Di Carli, M. F., Merhige, M. E., Williams, B. A., Veledar, E., … Beanlands, R. S. (2014). Prognostic value of PET myocardial perfusion imaging in obese patients. JACC Cardiovasc Imaging, 7(3), 278–287. https://doi.org/10.1016/j.jcmg.2013.12.008
Chow, Benjamin J. W., Sharmila Dorbala, Marcelo F. Di Carli, Michael E. Merhige, Brent A. Williams, Emir Veledar, James K. Min, et al. “Prognostic value of PET myocardial perfusion imaging in obese patients.JACC Cardiovasc Imaging 7, no. 3 (March 2014): 278–87. https://doi.org/10.1016/j.jcmg.2013.12.008.
Chow BJW, Dorbala S, Di Carli MF, Merhige ME, Williams BA, Veledar E, et al. Prognostic value of PET myocardial perfusion imaging in obese patients. JACC Cardiovasc Imaging. 2014 Mar;7(3):278–87.
Chow, Benjamin J. W., et al. “Prognostic value of PET myocardial perfusion imaging in obese patients.JACC Cardiovasc Imaging, vol. 7, no. 3, Mar. 2014, pp. 278–87. Pubmed, doi:10.1016/j.jcmg.2013.12.008.
Chow BJW, Dorbala S, Di Carli MF, Merhige ME, Williams BA, Veledar E, Min JK, Pencina MJ, Yam Y, Chen L, Anand SP, Ruddy TD, Berman DS, Shaw LJ, Beanlands RS. Prognostic value of PET myocardial perfusion imaging in obese patients. JACC Cardiovasc Imaging. 2014 Mar;7(3):278–287.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

March 2014

Volume

7

Issue

3

Start / End Page

278 / 287

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Severity of Illness Index
  • Rubidium Radioisotopes
  • Risk Factors
  • Registries
  • Prognosis
  • Predictive Value of Tests
  • Positron-Emission Tomography
  • Obesity