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Objective:Patients categorized Rutherford category IV might have different characteristics compared with Rutherford category V and VI. Our study aims were to estimate the clinical differences between Rutherford category IV and Rutherford category V and VI, for those underwent endovascular therapy for isolated infrapopliteal disease, and also to find risk factors for endovascular therapy in Rutherford category IV.Methods:Based on the Japanese multi-center registry data, 1091 patients with 1332 limbs (Rutherford category IV: 226 patients with 315 limbs, Rutherford category V and VI: 865 patients with 1017 limbs) were analyzed retrospectively.Results:Patients’ backgrounds and lesions’ characteristics had significant differences. Both freedom rate from major adverse limb event with perioperative death and amputation-free survival rate at 1 year were better in Rutherford category IV than Rutherford category V and VI (93.6% vs 78.3%, 87.7% vs 66.7%) and those maintained to 3 years (p < 0.0001). Significant predictors for major adverse limb event/perioperative death were small body mass index (<18.5 kg/m3) and initial endovascular therapy success, and those for amputation-free survival were small body mass index (<18.5 kg/m3), non-ambulatory status, high systematic inflammatory reaction (C-reactive protein > 3.0 mg/dL), chronic obstructive pulmonary disease, and coronary artery disease in Rutherford category IV.Conclusion:From the present results, Rutherford category IV should be recognized to have quite different backgrounds and better outcome from Rutherford category V and VI.

Gated N-13 NH(3) PET combined with QGS provides information on both global and regional left ventricular function comparable to that obtained by gated Tc-99m perfusion myocardial SPECT in CAD patients.

he assessment of left ventricular (LV) function and volumes, together with myocardial perfusion, is important for prognostic stratification of patients with coronary artery disease (CAD). [1][2][3][4][5] The electrocardiographic (ECG) -gated acquisition technique with perfusion tracers for single-photon emission computed tomography (SPECT) has been established to assess global and regional LV function, and several automated quantitative algorithms, such as the Cedars-Sinai quantitative gated SPECT (QGS), have been developed for this purpose. 6-11 Several recent studies have applied these algorithms to positron emission tomography (PET), 12-16 which has several advantages over SPECT in that it produces high-quality imaging and has the capability of quantitative analysis of perfusion or metabolism. Nitrogen-13-ammonia ( 13 N-NH3) has been widely used for quantification of myocardial blood flow Circulation Journal Vol.69, February 2005 (MBF) in PET studies. [17][18][19][20] Although MBF and LV function should usually be closely related, they may disagree in some circumstances, such as myocardial stunning. Therefore, the integration of MBF and LV function is important for understanding of the pathophysiology of various disease conditions. In this regard, ECG-gated 13 N-NH3 PET is attractive because it enables simultaneous assessment of MBF and LV function, but this promising technique has not been systematically validated in a large patient cohort. Furthermore, the feasibility of assessing regional function has not been previously addressed. The aim of this study was to evaluate the feasibility of ECG-gated 13 N-NH3 PET to assess global and regional LV function in a relatively large cohort of patients with CAD in comparison with conventional left ventriculography (LVG) as the reference technique. Methods Study PopulationThe study group consisted of 54 consecutive patients (51 men, 3 women; age range: 30-85 years, mean age: 62.6± 12.4 years) with CAD documented by coronary angiography. Of these 54 patients, 34 had a previous myocardial infarction. All patients underwent both LVG and gated 13 N-NH3 PET at rest within 2 weeks of each other (mean duration 7.2 days). All patients had normal sinus rhythm, and Methods and ResultsFifty-four patients with CAD underwent gated 13 N-ammonia PET and LVG. The LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and ejection fraction (LVEF) by gated 13 N-ammonia PET were calculated using Cedars-Sinai automated quantitative gated single photon emission computed tomography (QGS) and compared with those obtained by LVG. The regional wall motion (RWM) was visually scored, and compared with that on LVG. There were good correlations between the 2 methods for LVEF, LVEDV and LVESV (R=0.828, R=0.821 and R=0.874 respectively). The RWM assessed by gated 13 N-ammonia PET also agreed well with that by LVG (complete agreement was 70.4%, =0.58). Conclusions Gated 13 N-ammonia PET combined with QGS works reasonably well for the assessment of both global and regional LV function in CAD p...

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