CardiacPETAlliance-logo-color-cropped
Cardiac PET Alliance - Patients Banner 2

How Cardiac PET Helps Black Patients

Black patients face some of the highest rates of ischemic heart disease in the country, yet standard cardiac non-invasive imaging sometimes misses the condition most likely to affect them. Cardiac PET can help to close that gap.

Join the Alliance
The diagnostic gap

A Higher Risk. A Wider Gap.

Black patients have higher rates of ischemic heart disease, small-vessel heart disease and cardiovascular mortality than white patients.

Prior research has shown that Black patients are more likely than white patients to have symptoms of ischemic heart disease—like chest pain—without significant blockages in their heart arteries. In addition, in one study, Black patients who had abnormal SPECT stress tests and were taken for invasive procedures to look for blockages were less likely than white patients to have severe ones. In both scenarios, microvascular disease is likely an underlying contributor. Cardiac PET is the single best and most efficient noninvasive test for distinguishing large- and small-vessel problems and arriving at a diagnosis.

When a Black patient with coronary microvascular disease undergoes an exercise stress test or SPECT nuclear stress test, the results often come back normal, even when something is seriously wrong. He's told his heart is fine. She's told her symptoms are something else. They go home without answers or are sent for invasive procedures that carry real risks and, more often than not, find no blockage at all.

The data makes it clear: this is a systemic failure.

Zhang L, et al. Differences in Cardiovascular Risk, Coronary Artery Disease, and Cardiac Events Between Black and White Individuals Enrolled in the PROMISE Trial. JAMA Cardiology. 2022;7(3):259–267. PMID: 34935857. View Study →

Whittle J, et al. Racial Differences in Prevalence of Coronary Obstructions Among Men with Positive Nuclear Imaging Studies. Journal of the American College of Cardiology. 2006;47(10):2034–2041. PMID: 16697322. View Study →

 

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.

Black patients presenting with symptoms of ischemic heart disease and heart attacks have lower rates of obstructive blockages than white patients.

Annual ischemic heart disease death rates range from 0.8% to 6.5% for African American patients, compared with 0.2% to 2.8% for white patients at comparable scan severity levels.

CMD accounts for 53–64% of patients with ischemia and no obstructive coronary artery disease in large PET-based studies.

Undiagnosed CMD is associated with up to a 5-fold increase in major cardiac events when left untreated.

Brothers RM, et al. Racial Disparities in Cardiovascular Disease Risk: Mechanisms of Vascular Dysfunction. American Journal of Physiology — Heart and Circulatory Physiology. 2019;317:H777–H789. PMID: 31397168. View Study →



Shaw LJ, et al. Ethnic Differences in the Prognostic Value of Stress Technetium-99m Tetrofosmin Gated SPECT Myocardial Perfusion Imaging. Journal of the American College of Cardiology. 2005;45(9):1494–1504. PMID: 15862425. View Study →



Bullock-Palmer RP, et al. Microvascular Vasoregulatory Dysfunction in African Americans: An Enhanced Opportunity for Early Prevention and Treatment of Atherosclerotic Cardiovascular Disease. American Heart Journal Plus. 2024;40:100382. PMID: 38586429. View Study →



Del Buono MG, et al. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2021;78(13):1352–1371. PMID: 34556322. View Study →

The Problem

Why Black Women Are Particularly Vulnerable

The diagnostic gap is compounded for Black women in ways that are particularly difficult to close.

Research from the Women's Ischemia Syndrome Evaluation study found that Black women with ischemia and no obstructive coronary artery disease had a 2-fold increased risk for major adverse cardiovascular events and more than double the risk for cardiovascular mortality over 10 years compared with women of other races and ethnicities, independent of age or other risk factors.

Critically, Black women with this condition were less likely to report chest pain and more likely to report stomach-related symptoms such as heartburn or abdominal discomfort. Those perceived noncardiac presentations delay appropriate diagnostic interventions and may be one reason Black women face higher rates of angina hospitalization despite having no obstructive coronary disease.

Luu JM, et al. Long-Term Adverse Outcomes in Black Women With Ischemia and No Obstructive Coronary Artery Disease: A Study of the WISE Cohort. Circulation. 2023;147:617–619. PMID: 36780383. View Study →

WHY CARDIAC PET IS DIFFERENT

A Test That Sees the Full Picture for Every Patient

Cardiac PET measures myocardial blood flow — how well blood moves through both the large and small vessels of the heart.  That means it can detect coronary microvascular disease that treadmill stress tests, echocardiograms, and traditional nuclear imaging cannot diagnose.
 
PET is also more accurate than SPECT—the other major nuclear stress test modality—for diagnosing blockages in the large vessels of the heart. The diagnostic gap between PET and SPECT is striking. In a prospective head-to-head study, 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.
 
Cardiac PET also uses significantly less radiation than standard nuclear imaging (approximately 3–4 mSv compared to 7–15 mSv with SPECT), making it a safer test.
 
For Black patients who have been told their heart is fine when something is seriously wrong, cardiac PET can be the first test that provides a real answer and a path to treatment.

Patel FS, et al. Reclassification of Severe Ischemia on PET Versus SPECT MPI Using a Same-Patient Simultaneous Imaging Protocol. JACC Cardiovascular Imaging. 2022;15(6):1158–1159. PMID: 35680222. View Study →

Alam L, et al. Improved Performance of PET Myocardial Perfusion Imaging Compared to SPECT in the Evaluation of Suspected CAD. Current Cardiology Reports. 2023;25:281–293. PMID: 36826689. View Study →