Incremental prognostic value of digital positron emission tomography derived myocardial flow reserve: A prospective cohort study

Ahmed Ibrahim Ahmed, Mahmoud Al Rifai, Fares Alahdab, Jean Michel Saad, Yushui Han, Moath Said Alfawara, Faisal Nabi, John J. Mahmarian, Mouaz H. Al-Mallah

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


BACKGROUND: Positron Emission Tomography (PET) Myocardial Perfusion Imaging (MPI) is a robust diagnostic and prognostic test in patients with suspected or known coronary artery disease (CAD). We aimed to assess the incremental prognostic value of myocardial flow reserve (MFR) using the latest generation of digital PET scanners.

METHODS: Consecutive patients with clinically indicated PET MPI for suspected or known CAD were included. Myocardial blood flow (MBF) in ml/min/g was obtained from dynamic images at rest and peak hyperemia, and the myocardial flow reserve (MFR) was calculated as the ratio of stress to rest MBF. Patients were followed from the date of PET imaging for the occurrence of the primary outcome (composite of all-cause death, myocardial infarction, and Percutaneous Coronary Intervention or Coronary Artery Bypass Graft occurring >90 days after imaging). Nested multivariable Cox regression models were used to assess the incremental prognostic role of MFR over traditional risk factors and PET relative perfusion parameters.

RESULTS: The final cohort consisted of 3534 patients (mean age 67 ± 12 years, 48% female, 67% Caucasian, 53% obese, 55% hypertension, 32% diabetes, 42% dyslipidemia). During a median follow-up of 8.5 (3.0-15.4) months, 229 patients (6.5%, 6.4 per 1000 person-years) experienced the primary outcome. In nested multivariable Cox models, impaired MFR (MFR < 2) was significantly associated with the primary outcome (HR 2.9, 95% CI 2.0-4.1, p < 0.001) and significantly improved discrimination (Harrell's C 0.77, p = 0.002).

CONCLUSION: MFR derived from digital PET scanners has an independent and incremental prognostic role in patients with suspected or known CAD.

Original languageEnglish (US)
Pages (from-to)465-471
Number of pages7
JournalInternational Journal of Cardiology
StatePublished - Jan 15 2023


  • CFR
  • MBF
  • MFR
  • PET
  • Myocardial Perfusion Imaging/methods
  • Prognosis
  • Prospective Studies
  • Humans
  • Middle Aged
  • Male
  • Coronary Circulation/physiology
  • Coronary Artery Disease/diagnostic imaging
  • Fractional Flow Reserve, Myocardial
  • Myocardium
  • Female
  • Aged
  • Positron-Emission Tomography/methods

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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