TY - JOUR
T1 - Diagnostic value of PET-measured longitudinal flow gradient for the identification of coronary artery disease
AU - Valenta, Ines
AU - Quercioli, Alessandra
AU - Schindler, Thomas H.
N1 - Funding Information:
This study was supported by a departmental fund from Johns Hopkins University , with contributions of the Clinical Research Center, University Hospital, and Faculty of Medicine, Geneva; the Louis-Jeantet Foundation; and the Swiss Heart Foundation. Dr. Schindler has received research grant no. 3200B0-122237 from the Swiss National Science Foundation ; and has received support from the Gustave and Simone Prévot fund . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/4
Y1 - 2014/4
N2 - Objectives The purpose of this study was to evaluate the diagnostic value of a positron emission tomography (PET)/computed tomography (CT)-determined longitudinal decrease in myocardial blood flow (MBF) gradient during hyperemia and myocardial flow reserve (MFR) for the identification of epicardial stenosis ≥50%. Background Although PET-determined reductions in MFR are increasingly applied to identify epicardial lesions in coronary artery disease (CAD), it may be seen as a suboptimal approach due to the nonspecific origin of decreases in MFR. Methods In 24 patients with suspected or known CAD, MBF was measured with 13N-ammonia and PET/CT in ml/g/min at rest, during dipyridamole stimulation, and the corresponding MFR was calculated. MBF was also determined in the mid and mid-distal myocardium of the left ventricle (LV). A decrease in MBF from mid to mid-distal LV myocardium was defined as longitudinal MBF gradient. MBF parameters were determined in the myocardial region with stress-induced perfusion defect and with stenosis ≥50% (territory 1), without defect but with stenosis ≥50% (territory 2), or without stenosis ≥50% (territory 3). Results In territories 1 and 2 with focal stenosis ≥50%, the severity of epicardial artery stenosis correlated with the Δlongitudinal MBF gradient (stress-rest) (r = 0.52; p < 0.0001), while this association was less pronounced for corresponding MFR (r = -0.40; p < 0.003). On a vessel-based analysis, the sensitivity and specificity of the Δlongitudinal MBF gradient in the identification of epicardial lesions was higher than those for MFR (88% vs. 71%, p ≤ 0.044; and 81% vs. 63%, p = 0.134, respectively). Combining both parameters resulted in an optimal sensitivity of 100% and intermediate specificity of 75%. The diagnostic accuracy was highest for the combined analysis than for the Δlongitudinal MBF gradient or MFR alone (94% vs. 86%, p ≥ 0.003; and 94% vs. 70%, p ≤ 0.0002). Conclusions The combined evaluation of a Δlongitudinal MBF gradient and MFR may evolve as a new promising analytic approach to further optimize the identification of CAD lesions.
AB - Objectives The purpose of this study was to evaluate the diagnostic value of a positron emission tomography (PET)/computed tomography (CT)-determined longitudinal decrease in myocardial blood flow (MBF) gradient during hyperemia and myocardial flow reserve (MFR) for the identification of epicardial stenosis ≥50%. Background Although PET-determined reductions in MFR are increasingly applied to identify epicardial lesions in coronary artery disease (CAD), it may be seen as a suboptimal approach due to the nonspecific origin of decreases in MFR. Methods In 24 patients with suspected or known CAD, MBF was measured with 13N-ammonia and PET/CT in ml/g/min at rest, during dipyridamole stimulation, and the corresponding MFR was calculated. MBF was also determined in the mid and mid-distal myocardium of the left ventricle (LV). A decrease in MBF from mid to mid-distal LV myocardium was defined as longitudinal MBF gradient. MBF parameters were determined in the myocardial region with stress-induced perfusion defect and with stenosis ≥50% (territory 1), without defect but with stenosis ≥50% (territory 2), or without stenosis ≥50% (territory 3). Results In territories 1 and 2 with focal stenosis ≥50%, the severity of epicardial artery stenosis correlated with the Δlongitudinal MBF gradient (stress-rest) (r = 0.52; p < 0.0001), while this association was less pronounced for corresponding MFR (r = -0.40; p < 0.003). On a vessel-based analysis, the sensitivity and specificity of the Δlongitudinal MBF gradient in the identification of epicardial lesions was higher than those for MFR (88% vs. 71%, p ≤ 0.044; and 81% vs. 63%, p = 0.134, respectively). Combining both parameters resulted in an optimal sensitivity of 100% and intermediate specificity of 75%. The diagnostic accuracy was highest for the combined analysis than for the Δlongitudinal MBF gradient or MFR alone (94% vs. 86%, p ≥ 0.003; and 94% vs. 70%, p ≤ 0.0002). Conclusions The combined evaluation of a Δlongitudinal MBF gradient and MFR may evolve as a new promising analytic approach to further optimize the identification of CAD lesions.
KW - CAD
KW - MFR
KW - PET
KW - blood flow
KW - circulation
KW - coronary stenosis
KW - flow gradient
KW - microvascular function
KW - myocardial perfusion
UR - http://www.scopus.com/inward/record.url?scp=84898819025&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2014.01.001
DO - 10.1016/j.jcmg.2014.01.001
M3 - Article
C2 - 24631507
AN - SCOPUS:84898819025
SN - 1936-878X
VL - 7
SP - 387
EP - 396
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 4
ER -