Myocardial Perfusion Reserve in Ischemic Heart Disease

Neglia, Danilo; LʼAbbate, Antonio

doi:10.2967/jnumed.108.056317

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…This finding is in line with previous studies [26], and reflects the well-known discrepancy between the impairment in myocardial perfusion and the presence of epicardial disease. Such a mismatch could not represent the presence of real false positive results, but more likely represents the effects of coronary microvascular disease and/or non critical atherosclerotic lesions on myocardial perfusion as measured by PET [15,39]. It is well know that coronary stenosis (even with FFR measurement) and perfusion provide different and complementary information, which could be discordant [40][41][42].…”

Section: Discussionmentioning

confidence: 91%

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

Berti

Sciagrà

Neglia

et al. 2016

Eur J Nucl Med Mol Imaging

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Section: Discussionmentioning

confidence: 91%

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

Berti

Sciagrà

Neglia

et al. 2016

Eur J Nucl Med Mol Imaging

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“…Likewise, in the heart failure patient with LV dilation and impaired contractile function the differential between severe triple vessel CAD and the microvascular disease associated with diabetes, hypertension and obesity is best made by PET hybrid CT exam, particularly in patients with low to intermediate risk of CAD and normal renal function. As noted above, the physiological information obtained concerning maximal dilator capacity of the coronary circulation has considerable prognostic value over and above traditional indicators such as left ventricular ejection fraction and extent of epicardial CAD [56, 57] and so provides further justification for a combined physiological anatomical exam as opposed to a purely anatomical one (i.e., invasive coronary arteriography). The point, therefore, is to “choose wisely” [15••, 16, 17].…”

Section: Discussionmentioning

confidence: 99%

“…The hybrid PET-CT study is best suited to heart failure patients with low to intermediate prior probability of CAD in whom the primary purpose of the procedure is to exclude extensive CAD as the etiology of heart failure and thereby avoid the risks and expense of invasive coronary angiography. It also should be noted the functional information gained regarding maximal dilator capacity of the coronary circulation carries important prognostic information which may be more predictive of cardiac death than either left ventricular ejection fraction [56] or extent of epicardial CAD [57]. Once the coronary anatomy has been defined follow up examination(s) for assessment of the functional status of the coronary circulation, should they be required, may be accomplished by PET measurement of maximal MBF alone.…”

Section: Evaluation Of Patients With Heart Failurementioning

confidence: 99%

Cardiac PET-CT for Monitoring Medical and Interventional Therapy in Patients with CAD: PET Alone Versus Hybrid PET-CT?

Truong

Gewirtz

2014

Curr Cardiol Rep

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This review focuses on optimal use of PET and PET-CT in monitoring medical and interventional therapy in patients with CAD. PET provides quantitative measurement of absolute myocardial blood flow and thus permits comprehensive physiological assessment of the coronary circulation. Hybrid PET-CT, in particular CCTA, adds anatomical information to maximal MBF measurement and so facilitates distinction of triple vessel focal epicardial disease from coronary microvascular disease or diffuse coronary atherosclerosis without focal stenoses. Hybrid PET-CT also may be of value in determining appropriateness and feasibility of percutaneous interventional therapy for chronic total coronary occlusion. PET alone, however, is the preferred modality to address functional status of the coronary circulation and response over time, if required, to medical or interventional therapy. CT at a minimum provides attenuation correction. More detailed CCTA should be added only when a well-defined need for anatomical information is required to answer the clinical question posed.

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Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water

Prior

Allenbach

Valenta

et al. 2012

Eur J Nucl Med Mol Imaging

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PurposeQuantification of myocardial blood flow (MBF) with generator-produced 82Rb is an attractive alternative for centres without an on-site cyclotron. Our aim was to validate 82Rb-measured MBF in relation to that measured using 15O-water, as a tracer 100% of which can be extracted from the circulation even at high flow rates, in healthy control subject and patients with mild coronary artery disease (CAD).MethodsMBF was measured at rest and during adenosine-induced hyperaemia with 82Rb and 15O-water PET in 33 participants (22 control subjects, aged 30 ± 13 years; 11 CAD patients without transmural infarction, aged 60 ± 13 years). A one-tissue compartment 82Rb model with ventricular spillover correction was used. The 82Rb flow-dependent extraction rate was derived from 15O-water measurements in a subset of 11 control subjects. Myocardial flow reserve (MFR) was defined as the hyperaemic/rest MBF. Pearson’s correlation r, Bland-Altman 95% limits of agreement (LoA), and Lin’s concordance correlation ρc (measuring both precision and accuracy) were used.ResultsOver the entire MBF range (0.66–4.7 ml/min/g), concordance was excellent for MBF (r = 0.90, [82Rb–15O-water] mean difference ± SD = 0.04 ± 0.66 ml/min/g, LoA = −1.26 to 1.33 ml/min/g, ρc = 0.88) and MFR (range 1.79–5.81, r = 0.83, mean difference = 0.14 ± 0.58, LoA = −0.99 to 1.28, ρc = 0.82). Hyperaemic MBF was reduced in CAD patients compared with the subset of 11 control subjects (2.53 ± 0.74 vs. 3.62 ± 0.68 ml/min/g, p = 0.002, for 15O-water; 2.53 ± 1.01 vs. 3.82 ± 1.21 ml/min/g, p = 0.013, for 82Rb) and this was paralleled by a lower MFR (2.65 ± 0.62 vs. 3.79 ± 0.98, p = 0.004, for 15O-water; 2.85 ± 0.91 vs. 3.88 ± 0.91, p = 0.012, for 82Rb). Myocardial perfusion was homogeneous in 1,114 of 1,122 segments (99.3%) and there were no differences in MBF among the coronary artery territories (p > 0.31).ConclusionQuantification of MBF with 82Rb with a newly derived correction for the nonlinear extraction function was validated against MBF measured using 15O-water in control subjects and patients with mild CAD, where it was found to be accurate at high flow rates. 82Rb-derived MBF estimates seem robust for clinical research, advancing a step further towards its implementation in clinical routine.

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Myocardial Perfusion Reserve in Ischemic Heart Disease

Cited by 7 publications

References 28 publications

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

Segmental quantitative myocardial perfusion with PET for the detection of significant coronary artery disease in patients with stable angina

Cardiac PET-CT for Monitoring Medical and Interventional Therapy in Patients with CAD: PET Alone Versus Hybrid PET-CT?

Quantification of myocardial blood flow with 82Rb positron emission tomography: clinical validation with 15O-water

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