Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit With Early Revascularization

Patel, Krishna; Spertus, John A.; Chan, Paul S.; Sperry, Brett W.; Thompson, Randall C.; Badarin, Firas Al; Kennedy, Kevin F.; Case, James A.; Courter, Staci; Saeed, Ibrahim M.; McGhie, A. Iain; Bateman, Timothy M.

doi:10.1016/j.jacc.2019.07.055

Cited by 86 publications

(48 citation statements)

References 23 publications

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“…cardiac events (1, 4,5,[26][27][28]. This also relates to the optimal application of PET MPI to patients with an intermediate likelihood of having CAD.…”

mentioning

confidence: 99%

“…This enables the accurate identification and description of the extent and severity of stress-induced ischemia in individuals with suspected CAD and intermediate and high pretest probability. In addition, the concurrent assessment of regional and global hyperemic MBF and MFR enables the detection and characterization of flow-limiting effects of each single vessel in multivessel disease (2,(4)(5)(6)(7)(8)10,11,(40)(41)(42)(43)(44)(45)(46), and reductions in global MFR also convey important and incremental prognostic information in patients with and without obstructive CAD (2,3,7,14,26,39,(46)(47)(48).…”

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confidence: 99%

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Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Schindler¹,

Bateman²,

Berman³

et al. 2020

J Nucl Med

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In the last decade, myocardial perfusion imaging (MPI) with PET has emerged to play a pivotal role in the clinical routine process for the detection of hemodynamically significant obstructive coronary artery disease (CAD) and cardiovascular risk stratification (1-5). The high spatial and contrast resolution in concert with photon attenuation-free images of PET have led to high image quality associated with the highest sensitivity and specificity of PET/CT perfusion imaging in the detection and characterization of CAD (1,2,6,7). In addition, the noninvasive evaluation and quantification of global and regional myocardial blood flow (MBF) in milliliters per gram per minute during hyperemic stress and at rest, as well as the calculation of the resulting myocardial flow reserve (MFR), extends the scope of standard MPI from the detection of advanced and flow-limiting epicardial CAD to a comprehensive assessment of ischemic burden. This improved scope results not only from the traditionally sought significant left main or multivessel disease, but also from the more recently appreciated cardiac effects of nonobstructive CAD and coronary microvascular disease (CMD), which conveys important diagnostic and incremental prognostic information (1,2,4-11). The increased availability and high sensitivity of PET MPI in concert with concerns about missed diagnoses, however, may at times lead to an inappropriate application of this technology. Thus, to avoid unnecessary financial burden on the health-care system and, in some cases, unnecessary exposure of patients to ionizing radiation, we have established a consensus document that outlines the most appropriate and cost-effective use of PET MPI. It is hoped that this expert guidance will help to render the use of PET MPI more consistent and will improve health-care outcomes for the targeted patient population while minimizing unnecessary imaging costs. The goal of this document is to describe the appropriate use of PET MPI in patients with suspected or known CAD and in patients with suspected microvascular angina. Through these recommendations, it is expected that PET MPI will be applied to benefit these patients in the most cost-effective manner. Representatives from the Society of Nuclear Medicine and Molecular Imaging (SNMMI), the American College of Cardiology (ACC), the American Society of Nuclear Cardiology (ASNC), the Canadian Cardiovascular Society (CCS), the Canadian Society of Cardiovascular Nuclear and CT Imaging (CSCNCTI), the Society of Cardiovascular CT (SCCT), the American Heart Association (AHA), the American College of Physicians (ACP), and the European Association of Nuclear Medicine (EANM) assembled as an autonomous workgroup to develop the following appropriate use criteria (AUC). This process was performed in accordance with the Protecting Access to Medicare Act of 2014. This legislation requires that all referring physicians consult AUC by using a clinical decision support mechanism before ordering any advanced diagnostic imaging services. Such services are de...

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“…cardiac events (1, 4,5,[26][27][28]. This also relates to the optimal application of PET MPI to patients with an intermediate likelihood of having CAD.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Schindler¹,

Bateman²,

Berman³

et al. 2020

J Nucl Med

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“…Tomografie (PET) ungekoppelt oder gekoppelt an ein CT-oder MRT-System bisher aufgrund der Kosten und des Ressourcenaufwands noch keine weite Verbreitung. Sie ist aber als Goldstandard zur quantitativen Perfusionsuntersuchung und damit zur Ischämietestung anerkannt[2]. Der myokardiale Blutfluss (ml/min/g), der ein Zusammenspiel koronarer Makro-und Mikrostrombahn ist, kann unmittelbar berechnet werden.…”

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Funktionelle Diagnostik zur Detektion myokardialer Ischämie

Gaede

2020

Aktuelle Kardiologie

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ZusammenfassungIn den aktuellen Leitlinien zum chronischen Koronarsyndrom (chronic coronary syndrome, CCS) spielt die funktionelle Diagnostik zur Detektion und Quantifizierung einer myokardialen Ischämie eine zentrale Rolle: Im Gegensatz zu rein anatomischen Verfahren kann diese nicht nur eine koronare Herzerkrankung diagnostizieren, sondern auch gleichzeitig das Patientenrisiko stratifizieren. Funktionelle diagnostische Verfahren sollten zunächst nicht invasiv, in jedem Falle aber – vor allem bei fehlendem nicht invasivem Nachweis – im Herzkatheter mittels Druckdrahtmessung angewendet werden. In den nicht invasiven Verfahren bestimmt die Größe des ischämischen Areals, ob eine Revaskularisation von prognostischem Nutzen für den Patienten ist, und entscheidet somit über die weitere interventionelle Therapie. In der invasiven Quantifizierung wird die hämodynamische Signifikanz einer Koronarstenose bestimmt. Die funktionelle Diagnostik ermöglicht zudem eine Aussage über die Funktion der Mikrostrombahn. Erkrankungen der Mikrostrombahn sind von vergleichbarer prognostischer Bedeutung wie Erkrankungen der Makrostrombahn, bedürfen jedoch weniger der interventionellen als der pharmakologischen Behandlung. Aktuelle technische Entwicklungen aller Modalitäten erweitern in unterschiedlicher Geschwindigkeit die diagnostische Genauigkeit und das Einsatzgebiet der einzelnen Verfahren. Nicht für alle Patienten sollte daher grundsätzlich die gleiche Diagnostik in die Wege geleitet werden. Die richtige Auswahl des nicht invasiven Tests sollte in Abhängigkeit von dem Patienten mit Berücksichtigung von Komorbiditäten, Symptomatik und Prätestwahrscheinlichkeit sowie lokaler Expertise getroffen werden. Gerade alte Patienten, die sich häufig mit atypischer Symptomatik präsentieren und höhere Komplikationsraten bei invasiven Verfahren aufweisen, profitieren hier besonders von einer wohl überlegten diagnostischen Strategie.

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“…Доказано, что результаты ОЭКТ более важны для прогноза, чем количество пораженных артерий при коронароангиографии (КАГ), потому что ОЭКТ дает возможность определения жизнеспособности миокарда. Так, выявление признаков перенесенного ИМ по данным функциональных методов в сочетании с окклюзией инфаркт-зависимой артерии на КАГ и отсутствием признаков жизнеспособности миокарда по результатам ОЭКТ с высокой вероятностью свидетельствует о наличии необратимых рубцовых изменений миокарда в области перенесенного ИМ и отсутствии показаний для чрескожных коронарных вмешательств [19]. В то же время, интенсивность накопления радиофармацевтических препаратов в миокарде, кровоснабжаемом инфаркт-зависимой артерией, может определяться особенностями нарушения его метаболизма [20,21].…”

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“…Однако, несмотря на наличие тенденции (более тяжелая ишемия приводит к более выраженному снижению ФВ после нагрузки), между показателями была выявлена слабая корреляционная зависимость. [24] Стресс-тест ухудшает показатели перфузии относительно покоя в 9 сегментах (10,11,12,13,16,17,18,19) из 19. Такая картина возникает преимущественно при левом типе кровообращения.…”

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Application of Perfusion Single Photon Emission Computed Tomography of the Myocardium in Pain-Free Myocardial Ischemia

ABDRAKHMANOVA¹,

AMIROV²,

Цибулькин³

2020

Arhivʺ vnutrennej mediciny

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This literature review provides data on the use of single-photon emission computed tomography of myocardium in silent myocardial ischemia. The presence of silent myocardial ischemia increases the risk of cardiovascular complications several times and may be the first manifestation of coronary heart disease. Assessing the state of morphofunctional processes in the myocardium is the main goal of diagnostic imaging using singlephoton emission computed tomography of the myocardium. This allows to get three-dimensional image of left ventricle with information about distribution of perfusion volume across myocardium, makes it possible to more accurately differentiate such condition as silent myocardial ischemia. Conducting single-photon emission computed tomography in ECG synchronization mode allows you to visualize the kinetics of the myocardial walls in different phases of the cardiac cycle and thereby simultaneously assess the functional state of the left ventricular myocardium. Indicators of contractile function of the left ventricular myocardium in areas of transient hypoperfusion can be predictors of cardiac events after myocardial infarction and independent predictors of perioperative cardiac events in patients undergoing cardiac surgery. Performing single-photon emission computed tomography in ECG-synchronization mode allows visualizing kinetics of myocardial walls in different phases of cardiac cycle and thereby simultaneously assessing functional state of left ventricle myocardium. In combination with physical exercise and pharmacological tests, it helps to identify coronary stenosis among patients with silent myocardial ischemia. Perfusion single-photon emission computed tomography of myocardium is a necessary tool for stratification and assessment of prognosis of cardiac diseases in asymptomatic patients.

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Extent of Myocardial Ischemia on Positron Emission Tomography and Survival Benefit With Early Revascularization

Cited by 86 publications

References 23 publications

Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Appropriate Use Criteria for PET Myocardial Perfusion Imaging

Funktionelle Diagnostik zur Detektion myokardialer Ischämie

Application of Perfusion Single Photon Emission Computed Tomography of the Myocardium in Pain-Free Myocardial Ischemia

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