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European Journal of Nuclear Medicine and Molecular Imaging

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19.05.2018 | Original Article

Sex differences in the long-term prognostic value of ¹³N-ammonia myocardial perfusion positron emission tomography

verfasst von: Catherine Gebhard, Michael Fiechter, Bernhard A. Herzog, Christine Lohmann, Susan Bengs, Valerie Treyer, Michael Messerli, Dominik C. Benz, Andreas A. Giannopoulos, Christoph Gräni, Aju P. Pazhenkottil, Ronny R. Buechel, Philipp A. Kaufmann

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 11/2018

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Abstract

Purpose

Evidence to date on the unique female determinants of cardiovascular risk is inadequate. Positron Emission Tomography (PET) is considered to have the highest accuracy for the assessment of myocardial perfusion in patients with suspected coronary artery disease (CAD), but its long-term prognostic accuracy in women has not been established.

Methods

A total of 619 consecutive patients (138 women, mean age 60.0 ± 11.8 years) underwent clinically indicated ¹³N-ammonia PET at our institution and were followed up (median 5.7 years) for major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for any cardiac reason and late revascularization.

Results

During follow-up, 271 patients had at least one cardiac event, including 64 cardiac deaths and 33 nonfatal myocardial infarctions. In both women and men, abnormal myocardial perfusion was associated with reduced event-free survival (log rank p < 0.001). In women, abnormal myocardial perfusion was associated with a higher risk of a worse outcome than in men (adjusted HR 4.1, 95% CI 1.8–9.0 in women; HR 2.4, 95% CI 1.5–3.8 in men; p_interaction < 0.001). In contrast, abnormal coronary flow reserve (CFR) was a significant predictor of 10-year MACE in men (p = 0.006) but not in women (p = NS). Accordingly, an interaction term of sex and abnormal myocardial perfusion or CFR was significant (p < 0.001).

Conclusion

While perfusion findings in ¹³N-ammonia PET provide effective risk stratification in women and men, CFR adds incremental prognostic value for long-term cardiac outcomes only in men. Refined strategies in noninvasive imaging are needed in women to improve CAD risk prediction.

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Titel: Sex differences in the long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography
verfasst von: Catherine Gebhard
Michael Fiechter
Bernhard A. Herzog
Christine Lohmann
Susan Bengs
Valerie Treyer
Michael Messerli
Dominik C. Benz
Andreas A. Giannopoulos
Christoph Gräni
Aju P. Pazhenkottil
Ronny R. Buechel
Philipp A. Kaufmann
Publikationsdatum: 19.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 11/2018
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4046-8

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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