The association of 18F-FDG PET/CT and biomarkers in confirming coronary microvascular dysfunction

Abstract

ObjectiveThe purpose of this study is to evaluate the association between PET/CT CFR and biomarkers combined in confirming the diagnosis of coronary microvascular dysfunction.ResultsA total of 28 patients (21 males and 7 females) were included in this descriptive observational study (both qualitative and quantitative). The mean patient age was 55.50 ± 10.21 years (range 27–70 years) and the median was 56.5 years (range 49–63 years). All patients underwent Echo, CAG and PET/CT scan. Chest tightness was the most common symptom in our study. Most patients had normal blood pressure (n = 18, 64.3%) while only (n = 10, 37.5%) had hypertension, and (n = 1, 3.6%) had diabetes mellitus. The mean HDL in CMVD (n = 25) and non-CMVD (n = 3) were 1.30 ± 0.39 and 1.08 ± 0.95, respectively, indicating that the difference between the groups was statistically significant (p = 0.04). Similarly, the mean HBA1c- (glycated haemoglobin) in CMVD (n = 25) and non-CMVD (n = 3) were 5.6 ± 0.53 and 5.0 ± 0.26, respectively, with (p = 0.03). Our findings managed to show the association between biomarkers and PET/CT CFR in confirming the diagnosis of coronary microvascular dysfunction.

Novel nuclear medical procedures in the detection of microvascular dysfunction

“…27 Thus, absolute flow measurements and myocardial flow reserve (MFR) enable discrimination between microvascular and macrovascular disease, which is evaluated through numerous studies, Figure 3 and Table 1. [29][30][31][32][33][34][35][36][37] MFR less than 1.5 is suggestible for MVD. Additionally, patchy heterogeneous resting myocardial perfusion quantified with Markovian homogeneity analysis predicts mild stress-induced perfusion abnormalities, consistent with MVD.…”

“…Fietcher et al noticed that the addition of absolute measurements of coronary flow reserve can increase the diagnostic accuracy of 13 N‐ammonia PET from 79% to 92% in prediction of obstructive CAD 27 . Thus, absolute flow measurements and myocardial flow reserve (MFR) enable discrimination between microvascular and macrovascular disease, which is evaluated through numerous studies, Figure 3 and Table 1 29–37 …”

“…34,37 It seems that CFR evaluated with PET/CT combined with assessment of biomarkers (HDL, RDW, HBA1C, BNP) can be a robust model in confirmation of MVD diagnosis. 29 On the other hand, RAAS activity (measured by renin concentration) and endothelin-1 should not be assessed in patients with potential MVD since they are not related. 35 Evaluation of MVD with PET is important since it has a prognostic value.…”

“…Reduced CFR was suggestible for the presence of MVD in patients with type II diabetes and syndrome X who were free of overt cardiovascular disease 34,37 . It seems that CFR evaluated with PET/CT combined with assessment of biomarkers (HDL, RDW, HBA1C, BNP) can be a robust model in confirmation of MVD diagnosis 29 . On the other hand, RAAS activity (measured by renin concentration) and endothelin‐1 should not be assessed in patients with potential MVD since they are not related 35 …”

Nuclear cardiology: an overview of radioisotope techniques used in the diagnostic workup of cardiovascular disorders

“…This is particularly helpful in risk stratification, since MVD is common among patients with chest tightness, and a long -term prognosis in MVD is similarly poor when compared with patients with obstructive coronary disease. [22][23][24] Unstable atherosclerotic plaques evaluation Unstable atherosclerotic plaque is a plaque that has a large necrotic lipid core, and the thickness of the connective tissue cap does not exceed 65 μm. Within the plaque, there is an enhanced inflammation dominated by macrophages and T cells.…”