scholarly journals The diagnostic value of measuring the momentary blood flow reserve versus non-invasive methods to detect myocardial ischemia in assessing the functional significance of borderline coronary artery stenoses

2017 ◽  
Vol 89 (4) ◽  
pp. 15-21
Author(s):  
D I Darensky ◽  
V V Gramovich ◽  
E A Zharova ◽  
A A Ansheles ◽  
V B Sergienko ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Stress Tests ◽  
Non Invasive ◽  
Flow Reserve ◽  
Coronary Stenoses

Aim. To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). Subjects and methods. The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50—70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4—7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. Results. SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888—0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. Conclusion. When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.

scholarly journals Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease

2021 ◽  
Vol 26 (12) ◽  
pp. 4746
Author(s):  
A. N. Maltseva ◽  
A. V. Mochula ◽  
K. V. Kopyeva ◽  
E. V. Grakova ◽  
K. V. Zavadovsky
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Single Photon ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Small Diameter ◽  
Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Flow Reserve ◽  
Artery Disease

Non-obstructive coronary artery disease is generally considered as a favorable type of pathology, however, a number of studies indicate that in non-obstructive atherosclerosis, the risk of such cardiovascular events as myocardial infarction, ischemic stroke, sudden cardiac death and decompensated heart failure cannot be completely ruled out. This may be due to microvascular dysfunction. However, due to the small diameter of vessels, none of the imaging techniques used in clinical practice makes it possible to assess microvascular morphology. To date, the most well-established methods for assessing myocardial perfusion are single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The ability to quantify myocardial blood flow and coronary flow reserve allows SPECT and PET to be the methods of choice for non-invasive diagnosis of microvascular dysfunction. This review is devoted to current data on the clinical significance of radionuclide diagnosis of microvascular dysfunction in patients with non-obstructive coronary artery disease.

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

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.

scholarly journals Association of the Extent of Myocardial Ischemia with Outcomes in Patients with Suspected Coronary Artery Disease

2020 ◽  
Author(s):  
Takao Kato ◽  
Mitsuru Momose ◽  
Yukari Uemura ◽  
Masanao Naya ◽  
Naoya Matsumoto ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Single Photon ◽  
Heart Diseases ◽  
Photon Emission ◽  
Suspected Coronary Artery Disease ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Artery Disease

Abstract Background: There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial. We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.Methods: From the data of 2780 patients with stable angina, who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests, 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year. Results: Patients with ≥10% myocardial ischemia (n=173) were older than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (9.1% vs. 1.2%, P<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant (adjusted hazard ratio [95% confidence interval], 2.40 [1.09-5.26], P=0.029).Conclusion: The presence of ≥10% myocardial ischemia was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.

Coronary Flow Reserve Assessment in Patients with Cad by Dynamic Single-Photon Emission Computed Tomography

2017 ◽  
pp. 72-81
Author(s):  
A. V. Mochula ◽  
K. V. Zavadovsky ◽  
S. L. Andreev ◽  
A. L. Krylov ◽  
Yu. B. Lishmanov
Keyword(s):  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Coronary Artery Diseases ◽  
Dynamic Spect ◽  
Flow Reserve ◽  
Artery Disease ◽  
Vessel Coronary Artery

Purpose: to assess the coronary flow reserve in patients with one,  two and multi-vessel coronary artery diseases by dynamic SPECT  using semiconductor (cadmium-zinctelluride)- based gamma camera.Material and methods.This work included 42 patients with stable  coronary artery diseases. The first group consisted of 12 (28.6%)  patients with single and two-vessel coronary artery disease (STCAD)  (8 males and 4 females; mean age 61.5 ± 3.8 years) with  intermediate (50–70%) and significant (>70%) coronary artery  stenosis. Second group included 30 (71.4%) patients with multi- vessel coronary artery diseases (MVCAD) (22 males and 8 females;  mean age 60.1 ± 4.3 years) with a lesion >70% in at least 2 major epicardial vessels according to invasive coronary angiography. All patients underwent rest-stress dynamic SPECT as well as conventional myocardial perfusion imaging with 99mTc-MIBI as a radiopharmaceutical. All scintigraphic images were  acquired on the hybrid SPECT/CT unit (GE Discovery NM/CT 570C).  Patient with STCAD underwent invasive FFR detection.Results.When comparing the results of MPI between the study  groups, there were no significant differences. ROC analysis showed  that the global MFR ≤ 1,42 allows to identify MVCAD with a  sensitivity and specificity 68% and 86,4%, for PSM, these values  are: 39.1% and 86.4% (AUC = 0.655, p < 0.05), respectively  (“gold” standard CAG). The sensitivity and specificity of the regional  MFR to identify the hemodynamic significance of coronary artery stenoses at a value of <1.33 was 100% (the “gold” standard of FFR). Most likely, high sensitivity and specificity in this case are associated with a small number of patients with true stenoses of FFR.Conclusion.The performance of standard MPI in combination with  dynamic single-photon emission computed tomography allows to  increase the diagnostic significance of the scintigraphic approach in  the evaluation of myocardial microcirculation disorders in multivessel coronary artery disease. Dynamic SPECT is a promising  method of noninvasive assessment of hemodynamic significance of  coronary artery stenoses.

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