From the Guidelines
Reduction of MBFR on MPS indicates a higher risk of major CAD events due to abnormalities in coronary blood flow. This is based on the most recent guidelines from the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines, which state that reduced MBFR reflects abnormalities of flow within the epicardial coronary arteries, microvasculature, or both, and independently predicts risk of major CAD events 1. Key points to consider include:
- Measurement of MBFR can be effectively accomplished using PET or CMR, with normal MBFR being helpful in excluding high-risk anatomy 1.
- Global reduced levels of MBFR (<2) may provide a better estimate of disease extent and severity, and non-obstructive CAD with reduced MBFR is more frequently observed in women 1.
- The reduction of MBFR is a significant indicator of coronary blood flow abnormalities, which can lead to major CAD events, and therefore, it is crucial to monitor and manage these patients accordingly. Some important considerations for managing patients with reduced MBFR include:
- Using imaging modalities such as PET or CMR to assess MBFR and guide treatment decisions 1.
- Implementing strategies to improve coronary blood flow and reduce the risk of major CAD events, such as lifestyle modifications, medical therapy, or invasive interventions, depending on the individual patient's needs and risk profile.
From the Research
Reduction of MBFR on MPS
The reduction of myocardial blood flow reserve (MBFR) on myocardial perfusion imaging (MPI) is associated with various cardiovascular outcomes.
- A lower MBFR is linked to a higher risk of all-cause mortality and major adverse cardiovascular events (MACE) 2, 3, 4.
- MBFR is a prognostic biomarker of adverse outcomes, and its quantification can be used to predict cardiovascular risk 2, 4.
- A reduction in MBFR indicates a decreased ability of the coronary arteries to increase blood flow in response to stress or demand, which can lead to ischemia and cardiovascular events 5, 3.
Diagnostic Value of MBFR
The diagnostic value of MBFR is significant, as it can identify patients with coronary artery disease (CAD) and predict their risk of adverse outcomes.
- MBFR is associated with the extent and severity of CAD, and its reduction is linked to a higher incidence of MACE 5, 3.
- The measurement of MBFR can be used to guide revascularization and medical therapy, and its incorporation into clinical decision-making may improve patient outcomes 2, 4.
Quantification of MBFR
The quantification of MBFR can be achieved using various methods, including positron emission tomography (PET) and cardiovascular magnetic resonance (CMR).
- The Yale-MQ software is a highly automatic method for quantifying global and regional MBF and MFR from dynamic 82Rb cardiac PET, and it provides precise assessments of lower limits of normal (LLN) values 6.
- The quantification of MBFR is essential for its clinical application, and its standardization is crucial for ensuring reproducible results 6.