ArticleCirculation2026
Incremental Prognostic Value of Subendocardial Myocardial Flow Reserve in Patients With Normal Perfusion.
Abstract readMulticenter Study
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Article in Circulation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Prognostic value of D-SPECT-derived myocardial flow reserve in detecting coronary microvascular disease and predicting outcomes after complete revascularization: a two-center pilot study.European journal of nuclear medicine and molecular imaging · 2026Article
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Authors and funding
38 authors.
Diana M LopezCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0001-6335-9625
Jenifer M BrownORCID 0000-0002-6647-639X
Sanjay DivakaranCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0003-0598-6502
Daniel M HuckORCID 0000-0003-4221-8078
Brittany N WeberCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0002-0177-2091
Jon HainerCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0002-0572-912X
Sylvain CarreCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).
Mark LemleyArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0002-1531-880X
Giselle RamirezArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0009-0004-3730-5075
Aakash ShanbhagArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0001-5199-3071
Paul KavanaghArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0002-2242-1936
Joanna X LiangArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).
Ron BlanksteinCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0002-8393-6562
Sharmila DorbalaCardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0003-1462-1185
Damini DeyArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0003-2236-6970
Stacey KnightIntermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT (S.K., V.T.L., S.M.).ORCID 0000-0003-0092-7327
Viet T LeIntermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT (S.K., V.T.L., S.M.).ORCID 0000-0001-6659-5332
Steve MasonIntermountain Medical Center Heart Institute, Intermountain Healthcare, Murray, UT; Department of Internal Medicine, University of Utah, Salt Lake City, UT (S.K., V.T.L., S.M.).
Samuel WoppererDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.W., P.C.).ORCID 0009-0001-4281-629X
Panithaya ChareonthaitaweeDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.W., P.C.).ORCID 0000-0002-3811-8712
Thomas L RosamondDepartment of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS (T.L.R.).ORCID 0009-0000-1417-8342
Jacek KwiecinskiDepartment of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland (J.K.).ORCID 0000-0001-8202-6359
Robert J H MillerDepartment of Cardiac Sciences, University of Calgary, Calgary, AB, Canada (R.J.H.M.).ORCID 0000-0003-4676-2433
Leandro SlipczukCardiology Division, Montefiore Health System/Albert Einstein College of Medicine, New York, NY (L.S.).ORCID 0000-0003-3091-3735
Mark I TravinDepartment of Radiology (Nuclear Medicine), Montefiore Einstein, Albert Einstein College of Medicine, Bronx, NY (M.I.T.).ORCID 0000-0003-0968-2143
Erick AlexandersonDepartment of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico (E.A., I.C.-J.).
Isabel Carvajal-JuarezDepartment of Nuclear Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico (E.A., I.C.-J.).ORCID 0000-0001-8764-6012
René R S PackardDivision of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (R.R.S.P.).ORCID 0000-0002-8520-5843
Mouaz H Al-MallahHouston Methodist DeBakey Heart & Vascular Center, Houston Methodist Academic Institute, Houston, TX (M.H.A.-M.).ORCID 0000-0003-2348-0484
Andrew J EinsteinDivision of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (A.J.E.).ORCID 0000-0003-2583-9278
Attila FeherSection of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (A.F.).ORCID 0000-0002-2561-4282
Wanda AcampaDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (W.A.).ORCID 0000-0003-2187-4076
Rupa SanghaniSection of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, IL (R.S.).
Ronny R BuechelDepartment of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland (R.R.B.).ORCID 0000-0001-8064-8904
Robert A deKempDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, ON, Canada (R.A.dK.).ORCID 0000-0001-9136-5563
Daniel S BermanArtificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0002-3793-9578
Piotr J Slomka *Artificial Intelligence in Medicine Research Center, Departments of Biomedical Sciences, Medicine, and Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (M.L., G.R., A.S., P.K., J.X.L., D.D., D.S.B., P.J.S.).ORCID 0000-0002-6110-938X
Marcelo F Di Carli *Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Boston, MA (D.M.L., B.N.W., J.H., S.C., R.B., S.D., M.F.D.).ORCID 0000-0003-3119-025X
Funding
Patient-specific Outcome Prediction from Cardiovascular Multimodality Imaging by Artificial IntelligenceR35HL161195 · NHLBI · CEDARS-SINAI MEDICAL CENTER · PI Piotr J Slomka · 2022 to 2026
$5.0MIntegrating Artificial Intelligence for Optimal Analysis of CardiacPET/CTR01EB034586 · NIBIB · CEDARS-SINAI MEDICAL CENTER · PI DI CARLI, MARCELO F, SLOMKA, PIOTR J · 2022 to 2025
$2.9MCardiac Perfusion, Structure, and Function across the Primary Aldosteronism SpectrumK23HL159279 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Jenifer Michelle Brown · 2022 to 2026
$1.0MAdvanced CV imaging and immunophenotyping to study coronary vascular health in psoriasisK23HL159276 · NHLBI · UT SOUTHWESTERN MEDICAL CENTER · PI WEBER, BRITTANY NICOLE · 2021 to 2025
$962kInterplay of Inflammation, Angiogenesis, and Coronary Microvascular Perfusion in Advanced Kidney DiseaseK23HL171893 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Daniel Michael Huck · 2025 to 2026
$388kNHLBI NIH HHS K23 HL159276NHLBI NIH HHS K23 HL159279NHLBI NIH HHS K23 HL171893NHLBI NIH HHS R35 HL161195NIBIB NIH HHS R01 EB034586
Abstract
backgroundAlthough the prognostic utility of positron emission tomography (PET) myocardial flow reserve (MFR) is well established, emerging data suggest that reduced subendocardial flows also predict adverse outcomes. However, the incremental value of subendocardial MFR (MFR
methodsWe studied patients in a multicenter PET registry with normal perfusion on stress/rest Rb-82 PET, excluding those with a previous history of coronary artery bypass surgery, heart transplantation, or left ventricular ejection fraction <40%. The optimal MFR
resultsAmong 6603 patients (normal N=4103; discordant N=885; abnormal N=1615) the mean age was 66.3±12.4 years, and 54% were women. Compared with the concordant-normal group, patients with discordant low-MFR
conclusionsSubendocardial MFR reveals clinically meaningful risk heterogeneity among patients with preserved transmural flow reserve, helping refine risk stratification beyond traditional PET metrics.
Indexed as
Coronary CirculationFractional Flow Reserve, MyocardialMyocardial Perfusion ImagingPositron-Emission TomographyAgedFemaleHumansMaleMiddle AgedPredictive Value of TestsPrognosisRegistriescoronary artery diseasemicrocirculationmyocardial perfusion imagingpositron-emission tomography
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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.