Incremental Prognostic Value of Regional Myocardial Flow Reserve Beyond Global Flow and Perfusion: REFINE PET

Abnormal regional myocardial flow reserve on PET predicts major adverse cardiac events in the international REFINE PET registry, with an adjusted hazard ratio of 1.34.

• Why it matters: Global myocardial flow reserve and perfusion can miss risk, and it is unclear whether regional MFR adds prognostic information beyond these conventional PET measures.
• What they did: In 35,391 patients from 13 sites undergoing 82Rb and 13N-ammonia PET MPI, regional MFR was assessed and tested for incremental prediction over clinical factors, global MFR, and stress total perfusion deficit.
• The result: Over 4.0 ± 2.9 years, 9,903 patients (28.0%) had MACE; regional MFR improved model fit (chi^2 4,784 to 4,871), discrimination (AUC 0.710 to 0.729), and reclassification (NRI 41.9%), and flagged higher risk even with normal perfusion and preserved global MFR (5.0%/year vs 2.8%/year).

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