Evidence map›Paper›PMID 38996910›Full record

ArticleJournal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology2024

Comparative effectiveness of positron emission tomography and single-photon emission computed tomography myocardial perfusion imaging for predicting risk in patients with cardiometabolic disease.

Daniel M Huck, Sanjay Divakaran, Brittany Weber, Jenifer M Brown, Diana Lopez, Ana Carolina do A H Souza, Jon Hainer, Ron Blankstein, Sharmila Dorbala, Marcelo Di Carli

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Cardiovascular imaging in 2024: review of current research and innovations.European heart journal. Imaging methods and practice · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniel M HuckCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dhuck@bwh.harvard.edu.
Sanjay DivakaranCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Brittany WeberCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jenifer M BrownCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Diana LopezCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ana Carolina do A H SouzaCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Jon HainerCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ron BlanksteinCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Sharmila DorbalaCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Marcelo Di CarliCardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Funding

The Harvard Clinical and Translational Science CenterUL1TR002541 · NCATS · HARVARD MEDICAL SCHOOL · PI NADLER, LEE MARSHALL · 2018 to 2022
$93.0M
TUFTS--FIELDINGP30AG031679 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI SHALENDER BHASIN · 2008 to 2026
$23.9M
Noninvasive Cardiovascular Imaging Research Training ProgramT32HL094301 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Marcelo F DI CARLI · 2010 to 2026
$7.8M
Cardiac Perfusion, Structure, and Function across the Primary Aldosteronism SpectrumK23HL159279 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Jenifer Michelle Brown · 2022 to 2026
$1.0M
Advanced CV imaging and immunophenotyping to study coronary vascular health in psoriasisK23HL159276 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI WEBER, BRITTANY NICOLE · 2021 to 2025
$962k
NCATS NIH HHS UL1 TR002541NHLBI NIH HHS K23 HL159276NHLBI NIH HHS K23 HL159279NHLBI NIH HHS T32 HL094301NIA NIH HHS P30 AG031679
6 · The paper itself

Abstract

backgroundThe epidemiology of coronary artery disease (CAD) has shifted, with increasing prevalence of cardiometabolic disease and decreasing findings of obstructive CAD on myocardial perfusion imaging (MPI). Coronary microvascular dysfunction (CMD), defined as impaired myocardial flow reserve (MFR) by positron emission tomography (PET), has emerged as a key mediator of risk. We aimed to assess whether PET MFR provides additive value for risk stratification of cardiometabolic disease patients compared with single-photon emission computed tomography (SPECT) MPI.

methodsWe retrospectively followed patients referred for PET, exercise SPECT, or pharmacologic SPECT MPI with cardiometabolic disease (obesity, diabetes, or chronic kidney disease) and without known CAD. We compared rates and hazards of composite major adverse cardiovascular events (MACEs) (annualized cardiac mortality or acute myocardial infarction) among propensity-matched PET and SPECT patients using Poisson and Cox regression. Normal SPECT was defined as a total perfusion deficit (TPD) of <5%, reflecting the absence of obstructive CAD. Normal PET was defined as a TPD of <5% plus an MFR of ≥2.0.

resultsAmong 21,544 patients referred from 2006 to 2020, cardiometabolic disease was highly prevalent (PET: 2308 [67%], SPECT: 9984 [55%]) and higher among patients referred to PET (P < 0.001). Obstructive CAD findings (TPD > 5%) were uncommon (PET: 21% and SPECT: 11%). Conversely, impaired MFR on PET (<2.0) was common (62%). In a propensity-matched analysis over a median 6.4-year follow-up, normal PET identified low-risk (0.9%/year MACE) patients, and abnormal PET identified high-risk (4.2%/year MACE) patients with cardiometabolic disease; conversely, those with normal pharmacologic SPECT remained moderate-risk (1.6%/year, P < 0.001 compared to normal PET).

conclusionsCardiometabolic disease is common among patients referred for MPI and is associated with a heterogenous level of risk. Compared with pharmacologic SPECT, PET with MFR can detect nonobstructive CAD including CMD and can more accurately discriminate low-risk from higher-risk individuals.

Indexed as

Coronary Artery DiseaseMyocardial Perfusion ImagingPositron-Emission TomographyTomography, Emission-Computed, Single-PhotonAgedFemaleHumansMaleMiddle AgedObesityRenal Insufficiency, ChronicRetrospective StudiesRisk AssessmentCardiovascular outcomesChronic kidney diseaseDiabetesObesityPET myocardial perfusion imaging

Identifiers

PMID38996910
PMCPMC11527573

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.