Design and Rationale of the APOLLO Registry: Integrated Assessment of Cardio-Renal Perfusion and Cardiovascular-Kidney-Metabolic Phenotyping Using 82 Rb-PET/CT
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Background
Cardiovascular-kidney-metabolic (CKM) syndrome encompasses interconnected diseases that share pathophysiological mechanisms, including microvascular dysfunction. Although rubidium-82 positron emission tomography/computed tomography (²Rb-PET/CT) is routinely used for myocardial perfusion imaging, its potential for integrated cardio-renal perfusion assessment and broader CKM phenotyping remains underexplored. We recently developed a compartment modelling approach to quantify renal perfusion from existing routine cardiac 82 Rb-PET/CT scans, enabling simultaneous assessment of myocardial and kidney perfusion. However, real-world registries integrating these phenotypes with clinical outcomes are lacking.
Aim
To establish a registry integrating 82 Rb-PET-derived myocardial and renal perfusion, CT-derived CKM imaging biomarkers, and detailed clinical and outcome data.
Methods
The APOLLO registry is a single-centre, retrospective database comprising approximately 1,200 consecutive patients who underwent myocardial perfusion imaging with 82 Rb-PET/CT at Alrijne Hospital (Leiderdorp, the Netherlands) between 2021-2023. Clinical, laboratory, medication, echocardiographic, and imaging data were retrospectively collected. Myocardial perfusion was quantified using myocardial blood flow and myocardial flow reserve, and renal perfusion using renal blood flow and effective renal plasma flow. Additional CT-derived biomarkers included measures of adiposity and frailty, great vessel diameters, and vascular calcification. Echocardiographic diastolic dysfunction grade, H 2 FPEF score, CKM stage, and major adverse cardiovascular events (MACE) were also collected.
Conclusion
The APOLLO registry integrates ²Rb-PET-derived myocardial and renal perfusion measurements with CT-derived CKM imaging biomarkers and clinical outcomes. This enables investigation of cardio-renal perfusion and their associations with CKM phenotypes and cardiovascular outcomes.
