Cardiac PET Resources & Educational Materials

Cardiac PET with myocardial blood flow measurement is now recommended as the preferred non-invasive cardiac imaging test by the American College of Cardiology and American Heart Association (ACC/AHA), the American Society of Nuclear Cardiology (ASNC), and the European Society of Cardiology (ESC). The 2026 ASNC position statement states there are no clinical scenarios or patient subgroups where cardiac PET should be excluded.

ASNC Position Statement, J Nucl Cardiol 2026; 2024 ESC Guidelines for Chronic Coronary Syndromes; 2023 ACC/AHA Guideline for Chronic Coronary Disease

Cardiac PET offers superior diagnostic accuracy, robust and reproducible myocardial blood flow quantification, significantly lower radiation exposure, and the ability to identify coronary microvascular disease, a condition SPECT cannot detect.

The performance gap is clinically meaningful. In a prospective head-to-head study, cardiac PET achieved a diagnostic accuracy of 85% compared to 77% for SPECT. SPECT missed 81% of high-risk cases that PET identified, and the false positive rate with SPECT was 15.6%, nearly three times higher than the 5.2% false positive rate with cardiac PET.

Patients managed with cardiac PET also undergo more than 50% fewer invasive coronary procedures, with total heart disease management costs reduced by approximately 30% and no increase in cardiac death or heart attack at one year.

Danad et al., JAMA Cardiology 2017; Patel et al., JACC Cardiovascular Imaging 2022; Merhige et al., J Nucl Med 2007

Cardiac PET is clinically beneficial across all patient populations, but it is particularly valuable for women and African American patients, who are disproportionately affected by coronary microvascular disease and most likely to be missed by standard imaging.

For African American patients specifically, nearly 47% of Black adults aged 20 and older have at least one form of cardiovascular disease, compared with 36% of white adults. Black men face a 70% elevated risk of heart failure relative to white men; Black women face a 50% elevated risk. Yet African American patients have lower rates of obstructive blockages than white patients, meaning standard imaging is least effective precisely where the disease burden is highest.

Research from the WISE study found that Black women with ischemia and no obstructive coronary artery disease had more than double the risk for cardiovascular mortality at 10 years compared with women of other races and ethnicities, independent of age or other risk factors. Critically, Black women with this condition were more likely to present with stomach-related symptoms rather than chest pain, further delaying accurate diagnosis.

Cardiac PET is also uniquely well-suited for rural and underserved patients through mobile cardiac PET/CT services.

Brothers et al., Am J Physiol Heart Circ Physiol 2019; Luu et al., Circulation 2023; Shaw et al., J Am Coll Cardiol 2005

Cardiac PET is billed under specific CPT codes for myocardial perfusion imaging, with myocardial blood flow measurement available as an add-on CPT code.

The Cardiac PET Alliance is a coalition of cardiologists, imaging specialists, healthcare partners, and patients committed to protecting access to cardiac PET technology for every patient who needs it. The Alliance advocates for stable Medicare reimbursement policies and works to raise awareness of cardiac PET's clinical benefits and unique diagnostic capabilities.

There is growing concern that the Relative Value Scale Update Committee (RUC) and Medicare may consider reductions to cardiac PET reimbursement. Such cuts could make cardiac PET economically unviable for independent practices and mobile programs, concentrating access in large hospital systems and leaving patients in smaller and rural communities without a local option. The Alliance was formed to prevent that from happening before any cuts are proposed.

Contact Pepper Foster at pfoster@cardiacpetalliance.com

Cardiac PET (positron emission tomography) is an advanced, non-invasive cardiac imaging test that measures how well blood flows through the heart. Unlike standard imaging tests, it evaluates both the large and small vessels of the heart, giving physicians a complete picture of cardiac health that no other non-invasive test can provide.

Standard cardiac imaging tests — including stress tests, echocardiograms, and traditional nuclear imaging — are designed to detect obstructive coronary artery disease, the kind that shows up as a blockage in a large vessel. They cannot detect coronary microvascular disease, a condition that affects the small vessels of the heart. Cardiac PET can detect both — making it the only non-invasive test that sees the full picture.

The difference in accuracy is significant. In a prospective head-to-head comparison, cardiac PET achieved a diagnostic accuracy of 85% — outperforming both SPECT (77%) and coronary CT angiography (74%). In the same patients, SPECT missed 81% of high-risk cases that PET identified. Among patients with severe ischemia on PET and obstructive disease who may have benefited from intervention, nearly three in four had less-than-severe ischemia on SPECT.

Danad et al., JAMA Cardiology 2017; Patel et al., JACC Cardiovascular Imaging 2022

Coronary microvascular disease affects the small vessels of the heart rather than the large ones. It accounts for 30–50% of the burden of ischemic heart disease and is present in up to two-thirds of patients with ischemia and no obstructive coronary artery disease. It disproportionately affects women and African Americans, and is associated with up to a 5-fold increase in major cardiac events when left untreated. Because standard imaging tests cannot detect it, many patients with CMD are told their heart is fine, even when something is seriously wrong.

Del Buono et al., J Am Coll Cardiol 2021; Ford et al., Circ Cardiovasc Interv 2019

Yes. Cardiac PET uses significantly less radiation than traditional nuclear cardiac imaging, approximately 3–4 mSv compared to 7–15 mSv with SPECT. That represents a reduction of more than 50% in radiation exposure, making cardiac PET a safer option, particularly for patients who require repeat testing.

Alam et al., Current Cardiology Reports 2023

If you have been told your heart is fine but continue to experience symptoms such as chest pain, shortness of breath, or fatigue, you may be a candidate for cardiac PET. Speak with your cardiologist about whether cardiac PET with myocardial blood flow measurement is appropriate for your situation.