Incremental value of 18 F-FDG cardiac PET imaging over dobutamine stress echocardiography in predicting myocardial ischemia in patients with suspected coronary artery disease

Background To assess the incremental value of 18 F-fluorodeoxyglucose (FDG) cardiac positron emission tomography (PET) over dobutamine stress echocardiography (DSE) in predicting myocardial ischemia in patients with suspected coronary artery disease (CAD). Methods Forty-one patients with suspected CAD underwent within 7 days apart rest-stress cardiac PET with 82 Rb and DSE followed by cardiac 18 F-FDG PET imaging. 18 F-FDG images were scored on a 0 (no discernible uptake) to 2 (intense uptake) scale. Logistic regression analysis was performed to identify predictors of stress-induced ischemia. The incremental value of 18 F-FDG PET over DSE in detecting ischemia at 82 Rb PET cardiac imaging was assessed by the likelihood ratio chi-square and net reclassification index. Results On 82 Rb-PET imaging, myocardial ischemia (ischemic total perfusion defect ≥ 5%) was detected in 20 (49%) patients. Inducible ischemia was found in 22 (54%) patients on DSE (biphasic or worsening response pattern in ≥ 1 segment) and in 21 (51%) patients on 18 F-FDG PET (uptake score of 2 in ≥ 1 segment). 18 F-FDG PET resulted as statistically significant predictor of ischemia on 82 Rb-PET. The addition of 18 F-FDG PET to DSE increased the likelihood of ischemia on 82 Rb-PET ( P < .05). 18 F-FDG PET was able to reclassify the probability of stress-induced myocardial ischemia on both patient and vessel analyses. Conclusion 18 F-FDG PET performed after dobutamine stress test may provide incremental value to DSE in the evaluation of myocardial ischemia. These results suggest that stress-induced myocardial ischemia can be imaged directly using 18 F-FDG PET after dobutamine stress test.