Journal Of Nuclear Cardiology[JOURNAL]

BACKGROUND: Assessment of left ventricular function and dimensions is central for cardiac diagnostic imaging with cardiac positron emission tomography (PET) and myocardial perfusion single-photon emission computed tomogr... BACKGROUND: Assessment of left ventricular function and dimensions is central for cardiac diagnostic imaging with cardiac positron emission tomography (PET) and myocardial perfusion single-photon emission computed tomography (MPS). The aim of this study was to compare [N]NH PET and MPS, head-to-head, for assessment of left ventricular ejection fraction (LVEF) and volumes using cardiac magnetic resonance (CMR) as reference. METHODS: A total of 74 patients with suspected chronic coronary syndrome, of which 27 patients were examined twice 6 months apart, were included. All performed CMR and [N]NH PET on the same day, and MPS with cadmium-zinc-telluride technology within 1.0 ± 1.8 days. LVEF, end-diastolic volume (EDV) and end-systolic volume (ESV) by [N]NH PET and MPS using standard clinical reconstruction parameters as well as reconstructions with altered filters, subsets, and iterations were compared to CMR (bias±standard deviation). RESULTS: Using standard clinical reconstruction parameters, both PET and MPS underestimated EDV (-58 ± 23 mL and -77 ± 22 mL, respectively) and ESV (-31 ± 19 mL and -29 ± 16 mL, respectively) compared to CMR. For LVEF, the bias was 5±6% and -3±7% for PET and MPS, respectively. The bias was slightly lowered for EDV by altering reconstruction parameters of PET (-56 ± 23 mL) and MPS (-76 ± 23 mL) images. CONCLUSIONS: Left ventricular volumes by [N]NH PET and MPS are significantly underestimated compared to CMR when using standard clinical reconstruction parameters, whereas LVEF shows better agreement. Furthermore, there seems to be potential for improved accuracy of EDV, especially for [N]NH PET, when optimizing selected reconstruction parameters in the studied population.

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Beyond flow reserve: Comparative prognostic value of myocardial blood flow reserve, peak stress myocardial blood flow, and blood flow reserve corrected for resting rate pressure product in patients undergoing positron emission tomography myocardial perfusion imaging.

Khan MS, Bateman TM, Case JA … +1 more , Sperry BW

J Nucl Cardiol · 2026 Jan · PMID 41205795 · Publisher ↗

BACKGROUND: Global myocardial blood flow reserve (MBFR) demonstrates diagnostic and prognostic value beyond visual perfusion defect assessment. However, high resting rate-pressure product (RPP) can influence MBFR interpr... BACKGROUND: Global myocardial blood flow reserve (MBFR) demonstrates diagnostic and prognostic value beyond visual perfusion defect assessment. However, high resting rate-pressure product (RPP) can influence MBFR interpretation. Data are mixed regarding the importance of further stratifying MBFR by peak stress MBF or RPP-corrected MBFR (cMBFR) values. METHODS: This retrospective study consisted of consecutive patients referred for positron emission tomography myocardial perfusion imaging (PET MPI) at Saint Luke's Health System (2010-2016). Patients were categorized based on impaired or preserved levels of MBFR (<2 vs ≥ 2), cMBFR (<2 vs ≥ 2), and peak stress MBF (<1.7 vs ≥ 1.7 mL/min/g). All-cause mortality across groups was assessed using Kaplan-Meier and log-rank tests, with goodness-of-fit assessed using likelihood ratio tests. RESULTS: Of 13,632 consecutive patients referred for PET MPI, the median age was 70 (IQR: 61-77) years, 50.2 % were female, and the median follow-up was 8.3 years. Over the study period, 30.6 % of patients died; 73.5 % of whom had MBFR<2. Preserved MBFR was associated with the most favorable prognosis, regardless of cMBFR or peak stress MBF. Those with MBFR <2 and impairment of either peak stress MBF or cMBFR had the poorest prognosis. In those with MBFR<2, normal peak stress MBF identified a group with intermediate prognosis slightly better than the presence of preserved cMBFR (P = .012 vs .064, respectively). CONCLUSIONS: In this large cohort, normal MBFR predicted favorable outcomes independent of cMBFR or peak stress MBF. Inclusion of peak stress MBF beyond MBFR and traditional risk factors improved model fit compared to cMBFR and helped to risk stratify patients with impaired MBFR.

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The changes in myocardial perfusion imaging landscape. A look at the human factor.

Sciagrà R

J Nucl Cardiol · 2025 Dec · PMID 41203111 · Publisher ↗

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Re-evaluating stress testing paradigms in older adults.

Patel KK

J Nucl Cardiol · 2025 Dec · PMID 41203110 · Full text

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Heart rate response to regadenoson stress with positron emission tomography myocardial perfusion imaging: Old marker, new insights.

Doukky R

J Nucl Cardiol · 2025 Dec · PMID 41203109 · Publisher ↗

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Confirming expectations: Coronary artery calcification assessment provides diagnostic value in F18-flurpiridaz positron emission tomography myocardial perfusion imaging.

Feher A, Sinusas AJ

J Nucl Cardiol · 2025 Dec · PMID 41197709 · Publisher ↗

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Reduced occupational radiation exposure after rubidium-82 PET adoption: A 10-year observational study.

Major JD, Weinberg RL, Bourgeault V … +3 more , Harel F, Regis C, Pelletier-Galarneau M

J Nucl Cardiol · 2026 Jan · PMID 41177441 · Publisher ↗

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Improving prognostic risk assessment of cardiovascular events with machine learning: An evaluation using positron emission tomography myocardial perfusion imaging.

Alahdab F, El Shawi R, Ahmed AI … +2 more , Al Rifai M, Al-Mallah M

J Nucl Cardiol · 2026 Mar · PMID 41176053 · Publisher ↗

BACKGROUND: Machine learning (ML) holds potential for improving risk assessment in patients with suspected or confirmed coronary artery disease (CAD). However, certain approaches offer greater benefit than others for thi... BACKGROUND: Machine learning (ML) holds potential for improving risk assessment in patients with suspected or confirmed coronary artery disease (CAD). However, certain approaches offer greater benefit than others for this task, particularly to capture non-linearity between variables as well as case-by-case explainability. METHODS: We included consecutive patients who underwent clinically indicated positron emission tomography (PET) imaging. Using automated machine learning (AutoML) and unseen data for performance testing, clinical and PET variables were used to train the predictive models. A logistic regression (LR) and a deep feed-forward neural network (DNN) were trained on the same data for comparison. Major adverse cardiovascular events (MACEs) included death, myocardial infarction, or coronary revascularization >90 days after imaging. RESULTS: We included 8,357 patients (80% for development and 20% held out for testing), 46.3% females, with a mean (standard deviation) age of 67.2 (11.7) years. The median (interquartile range) myocardial flow reserve (MFR) was 2.1 (1.6 to 2.6). After an average follow-up of 589 days, a total of 852 patients (10.2%) experienced MACEs. The AutoML achieved an area under the receiver operator curve of .82 (95% confidence interval: .79 to .85) versus .79 (.76 to .82) and .76 (.73 to .80) for the LR and the DNN models, respectively. Model explainability showed that MFR topped the list of most impactful features, followed by total perfusion defects, serum creatinine, and diastolic blood pressure. CONCLUSIONS: An AutoML model integrating clinical and PET data discriminated MACE risk in CAD more accurately than LR or DNN models and provides interpretable patient-level explanations that can inform personalized care.

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Impact of hemoglobin concentration on quantitative cardiac perfusion measurements.

Svanström P, Kero T, Polte CL … +7 more , Sigfridsson J, Eggers KM, Johnston N, Brandt A, Harms HJ, Lubberink M, Sörensen J

J Nucl Cardiol · 2026 Jan · PMID 41173436 · Publisher ↗

BACKGROUND: Anemia is a prognostic factor in chronic coronary syndromes (CCS), but its impact on quantitative myocardial perfusion and potential sex differences remains unclear. We investigated whether hemoglobin concent... BACKGROUND: Anemia is a prognostic factor in chronic coronary syndromes (CCS), but its impact on quantitative myocardial perfusion and potential sex differences remains unclear. We investigated whether hemoglobin concentration (Hb) independently affects resting and stress myocardial blood flow (MBF) or myocardial flow reserve (MFR). METHODS: This retrospective study included patients with known or clinically suspected CCS who underwent cardiac O-water positron emission tomography (PET) and had available Hb data. PET parameters included resting and stress MBF, MFR, and forward stroke volume index (FSVi), calculated by dividing cardiac index derived from the indicator dilution technique by heart rate. Multivariable regression and mediation analyses were performed to determine the independent influence of Hb. RESULTS: We included 675 consecutive patients (45% female, age 66 ± 11 years, Hb 139 ± 14 g/L, 13% anemic). Heart rate, FSVi, Hb, sex, and systolic blood pressure (SBP) explained two-thirds of the variation in resting MBF (adjusted R = .66). In mediation analysis, the association between Hb and resting MBF was mainly direct, with partial mediation by FSVi only in females, and no mediation by heart rate or SBP. Hb was not associated with stress MBF in any sex (P ≥ .17). Anemia was associated with a higher proportion of low MFR (<2.5) despite normal stress MBF (20.9% vs. 9.3%, P = .004). CONCLUSIONS: Hemoglobin concentration affects resting myocardial blood flow but not stress MBF, indicating stress MBF may serve as a more robust and reliable measure of maximal coronary flow capacity than MFR, particularly in patients with anemia.

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