Prognostic value of myocardial flow reserve by PET imaging in patients with suspected coronary artery disease: A systematic review and meta-analysis

Purpose: We performed a systematic review and meta-analysis of published studies evaluating the value of myocardial flow reserve (MFR) assessed by positron emission tomography (PET) imaging in predicting adverse cardiovascular events in patients with suspected coronary artery disease (CAD). Material and methods: Studies published until December 2024 were identified by database search. We included studies evaluating MFR by PET imaging with data on adjusted hazard ratio (HR) for the occurrence of adverse cardiovascular events. Results: We identified 8 eligible articles including 12.087 patients with a mean follow-up of 2.98 ± 0.69 years. The pooled HR for the occurrence of events was 2.19 (95 % CI 1.80–2.68) and no heterogeneity was observed. The pooled incidence rate ratio (IRR) was 3.26 (95 % CI 2.43–4.37) and the heterogeneity was 37.7 %. At meta-regression analysis no significant association was found between HR for adverse events and demographic and clinical variables considered. Conclusion: MFR assessed by PET imaging is a valuable noninvasive prognostic indicator in the evaluation of patients with suspected CAD.