Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications

K. Lance Gould; Nils P. Johnson; Amanda E. Roby; Linh Bui; Danai Kitkungvan; Monica B. Patel; Tung Nguyen; Richard Kirkeeide; Mary Haynie; Salman A. Arain; Konstantinos Charitakis; Abhijeet Dhoble; Richard Smalling; Angelo Nascimbene; Marwan Jumean; Sachin Kumar; Biswajit Kar; Stefano Sdringola; Anthony Estrera; Igor Gregoric; Dejian Lai; Ruosha Li; David McPherson; Jagat Narula

doi:10.1093/eurheartj/ehad579

Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications

K. Lance Gould, Nils P. Johnson, Amanda E. Roby, Linh Bui, Danai Kitkungvan, Monica B. Patel, Tung Nguyen, Richard Kirkeeide, Mary Haynie, Salman A. Arain, Konstantinos Charitakis, Abhijeet Dhoble, Richard Smalling, Angelo Nascimbene, Marwan Jumean, Sachin Kumar, Biswajit Kar, Stefano Sdringola, Anthony Estrera, Igor GregoricDejian Lai, Ruosha Li, David McPherson, Jagat Narula

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8 Scopus citations

Abstract

Background and Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and Aims after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. Methods Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. Results Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). Conclusions Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.

Original language	English
Pages (from-to)	181-194
Number of pages	14
Journal	European Heart Journal
Volume	45
Issue number	3
DOIs	https://doi.org/10.1093/eurheartj/ehad579
State	Published - 14 Jan 2024
Externally published	Yes

Keywords

Coronary artery disease
Coronary bypass surgery
Coronary flow reserve
Myocardial ischaemia
Myocardial perfusion
PET imaging

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10.1093/eurheartj/ehad579

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Lance Gould, K., Johnson, N. P., Roby, A. E., Bui, L., Kitkungvan, D., Patel, M. B., Nguyen, T., Kirkeeide, R., Haynie, M., Arain, S. A., Charitakis, K., Dhoble, A., Smalling, R., Nascimbene, A., Jumean, M., Kumar, S., Kar, B., Sdringola, S., Estrera, A., ... Narula, J. (2024). Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications. European Heart Journal, 45(3), 181-194. https://doi.org/10.1093/eurheartj/ehad579

@article{dfa6e8d100a24a518c77d8948cee0f4b,

title = "Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications",

abstract = "Background and Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and Aims after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. Methods Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. Results Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). Conclusions Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.",

keywords = "Coronary artery disease, Coronary bypass surgery, Coronary flow reserve, Myocardial ischaemia, Myocardial perfusion, PET imaging",

author = "{Lance Gould}, K. and Johnson, {Nils P.} and Roby, {Amanda E.} and Linh Bui and Danai Kitkungvan and Patel, {Monica B.} and Tung Nguyen and Richard Kirkeeide and Mary Haynie and Arain, {Salman A.} and Konstantinos Charitakis and Abhijeet Dhoble and Richard Smalling and Angelo Nascimbene and Marwan Jumean and Sachin Kumar and Biswajit Kar and Stefano Sdringola and Anthony Estrera and Igor Gregoric and Dejian Lai and Ruosha Li and David McPherson and Jagat Narula",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2024",

month = jan,

day = "14",

doi = "10.1093/eurheartj/ehad579",

language = "English",

volume = "45",

pages = "181--194",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "3",

}

Lance Gould, K, Johnson, NP, Roby, AE, Bui, L, Kitkungvan, D, Patel, MB, Nguyen, T, Kirkeeide, R, Haynie, M, Arain, SA, Charitakis, K, Dhoble, A, Smalling, R, Nascimbene, A, Jumean, M, Kumar, S, Kar, B, Sdringola, S, Estrera, A, Gregoric, I, Lai, D, Li, R, McPherson, D & Narula, J 2024, 'Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications', European Heart Journal, vol. 45, no. 3, pp. 181-194. https://doi.org/10.1093/eurheartj/ehad579

TY - JOUR

T1 - Coronary flow capacity and survival prediction after revascularization

T2 - physiological basis and clinical implications

AU - Lance Gould, K.

AU - Johnson, Nils P.

AU - Roby, Amanda E.

AU - Bui, Linh

AU - Kitkungvan, Danai

AU - Patel, Monica B.

AU - Nguyen, Tung

AU - Kirkeeide, Richard

AU - Haynie, Mary

AU - Arain, Salman A.

AU - Charitakis, Konstantinos

AU - Dhoble, Abhijeet

AU - Smalling, Richard

AU - Nascimbene, Angelo

AU - Jumean, Marwan

AU - Kumar, Sachin

AU - Kar, Biswajit

AU - Sdringola, Stefano

AU - Estrera, Anthony

AU - Gregoric, Igor

AU - Lai, Dejian

AU - Li, Ruosha

AU - McPherson, David

AU - Narula, Jagat

PY - 2024/1/14

Y1 - 2024/1/14

N2 - Background and Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and Aims after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. Methods Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. Results Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). Conclusions Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.

AB - Background and Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and Aims after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. Methods Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. Results Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). Conclusions Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.

KW - Coronary artery disease

KW - Coronary bypass surgery

KW - Coronary flow reserve

KW - Myocardial ischaemia

KW - Myocardial perfusion

KW - PET imaging

UR - http://www.scopus.com/inward/record.url?scp=85172763366&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehad579

DO - 10.1093/eurheartj/ehad579

M3 - Article

C2 - 37634192

AN - SCOPUS:85172763366

SN - 0195-668X

VL - 45

SP - 181

EP - 194

JO - European Heart Journal

JF - European Heart Journal

IS - 3

ER -

Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications

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