Quantitative PET/CT measures of myocardial flow reserve and atherosclerosis for cardiac risk assessment and predicting adverse patient outcomes

Ines Valenta, Vasken Dilsizian, Alessandra Quercioli, Terrence D. Ruddy, Thomas H. Schindler

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Conventional scintigraphic myocardial perfusion imaging with SPECT/CT or with PET/CT has evolved as an important clinical tool for the diagnostic assessment of flowlimiting epicardial lesions and risk stratification of patients with suspected CAD. By determining the relative distribution of radiotracer-uptake in the left-ventricular (LV) myocardium during stress, the presence of flow-limiting CAD lesions can be identified. While this approach successfully identifies epicardial coronary artery lesions, the presence of subclinical and nonobstructive CAD may go undetected. In this direction, the concurrent ability of PET/CT to assess absolute myocardial blood flow (MBF) in ml/g/min, rather that relative regional distribution of radiotracer-uptake, and myocardial flow reserve (MFR), expands the scope of conventional myocardial perfusion imaging from the identification of more advanced and flow-limiting epicardial lesions to (1) subclinical CAD, (2) an improved characterization of the extent and severity of CAD burden, and (3) the discovery of "balanced" reduction in myocardial blood flow as a consequence of 3 vessel CAD. Concurrent to the PET data, the CT component of the hybrid PET/CT allows the assessment of coronary artery calcification as an indirect surrogate for CAD burden, without contrast, or with contrast angiography to directly denote coronary stenosis and/ or plaque morphology with CT. Hybrid PET/CT system, therefore, has the potential to not only identify and characterize flowlimiting epicardial lesions but also subclinical stages of functional and/or structural stages of CAD. Whether the application of PET/CT for an optimal assessment of coronary pathology, its downstream effects on myocardial perfusion, and coronary circulatory function will in effect lead to changes in clinical decision-making process, investiture in preventive health care, and improved long-term outcome, awaits scientific verification.

Original languageEnglish
Article number344
JournalCurrent Cardiology Reports
Volume15
Issue number3
DOIs
StatePublished - Mar 2013

Keywords

  • Atherosclerosis
  • Blood flow
  • Cardiovascular risk
  • Circulation
  • Coronary artery disease
  • Coronary circulatory function
  • Endothelium
  • Myocardial flow reserve
  • PET
  • PET/CT
  • Patient outcomes
  • Prognosis
  • Vasoreactivity

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