Relation of Coronary Flow Reserve to Other Findings on Positron Emission Tomography Myocardial Perfusion Imaging and Left Heart Catheterization in Patients With End-stage Renal Disease Being Evaluated for Kidney Transplant

This article summarizes data of the studies with positron emission tomography (PET) and devotes the clinical application of PET for myocardial blood flow and coronary flow reserve measurement in the patients with cardiovascular pathology. Measurement of myocardial blood flow and coronary flow reserve allows to assess the functional importance of coronary stenosis in patients with coronary heart disease. According the results of experimental and clinical studies the impairment of coronary vasomotor reactivity seems to be the main cause of coronary microcirculatory abnormalities in the patients with high risk of cardiovascular diseases. Noninvasive PET diagnostics of myocardial blood flow provides the valuable information for stratification of the risk of the severe cardiovascular complications. PET seems to be a good tool for assessment of the medical treatment efficiency of arterial hypertension, diabetes mellitus, hypercholesterolemia and hypoestrogenemia. Myocardial blood flow impairment is independent prognostic marker of future adverse cardiac events and sudden cardiac death in patients with hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy.

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Improved Assessment of Coronary Flow Impairment Using N-13 Ammonia Positron Emission Tomography

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone, Joint and Spine Mechanics; Brain Injury; Cardiac Mechanics; Cardiovascular Devices, Fluids and Imaging; Cartilage and Disc Mechanics; Cell and Tissue Engineering; Cerebral Aneurysms; Computational Biofluid Dynamics; Device Design, Human Dynamics, and Rehabilitation; Drug Delivery and Disease Treatment; Engineered Cellular Environments ◽

10.1115/sbc2013-14351 ◽

2013 ◽

Author(s):

Srikara Viswanath Peelukhana ◽

Kranthi K. Kolli ◽

Hanan Kerr ◽

Mohamed Effat ◽

Imran Arif ◽

...

Keyword(s):

Positron Emission Tomography ◽

Coronary Artery ◽

Coronary Flow ◽

Single Photon ◽

Photon Emission ◽

Left Ventricular ◽

Emission Tomography ◽

Emission Computed Tomography ◽

Flow Reserve ◽

Positron Emission

Non-invasive diagnosis of coronary artery disease (CAD) is achieved using rest and stress myocardial perfusion imaging (MPI) techniques. Currently, the MPI technique that is a standard of care is the Single Photon Emission Computed Tomography (SPECT). However, comparatively accurate and reliable MPI diagnostic test known as Positron Emission Tomography (PET) is also available and gaining increasing popularity. In this study, a comparison is made between the impairments and left ventricular (LV) ejection fraction (EF) reported by SPECT and PET. In addition, using PET data, flow defects were quantified using coronary flow reserve (CFR: ratio of flow at stress to the rest) in four coronary territories, left ventricle (LV), left circumflex (LCX), right coronary artery (RCA) and left anterior descending (LAD). Three patients with previous SPECT and suspected CAD were consented and further assessed with a PET cardiac N-13 ammonia scan according to the study protocol. The comparisons of the two imaging modalities showed discordance for patients 1 and 2 while they concurred for the patient 3. More importantly, quantification of the extent of defect showed an abnormal CFR value (< 2) of 1.67 (LCX) and 1.57 (RCA) for the patient 1 and 1.67 (LAD) and 1.75 (RCA) for patient 2. For the third patient, CFR value was abnormal at 0.85 for the RCA. Therefore, in contrast to SPECT, quantification of flow impairment using PET MPI in individual coronary territories will aid in better diagnosis of CAD.

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