Added Value of Transluminal Attenuation Gradient to Qualitative CCTA Ischemia Detection as Determined by 13N-ammonia PET Quantitative Myocardial Perfusion

Transluminal attenuation gradient (TAG) represents the slope of intraluminal contrast that decreases along a coronary vessel during coronary computed tomography angiography (CCTA). The aim of this study was to determine the added value of TAG to qualitative CCTA assessment of significant stenosis (>50%) detecting ischemia as determined by stress myocardial blood flow (MBF) or myocardial flow reserve (MFR) measured by positron emission tomography (PET). Individual contributions of TAG, qualitative assessment and the impact of calcium score were also investigated. Methods: We studied 38 consecutive patients that were referred due to suspected or known coronary artery disease (CAD). All patients underwent a two-phase hybrid 13N-ammonia PET/CT and CCTA. Results: TAG and presence of qualitatively assessed significant stenosis, but not calcium score, were associated with stress myocardial blood flow (MBF) and myocardial flow reserve (MFR). The area under the curves (AUC) of the linear predictor model including qualitative assessment and TAG was superior to the AUC of separate qualitative assessment or TAG for the detection of ischemia according to stress MBF (AUCs were: 88% vs. 79% and 77%; p = 0.01 and p = 0.01, respectively). Conclusions: TAG combined with qualitative CCTA assessment improved ischemia detection.

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Discordance between invasive coronary flow reserve (CFR) and non-invasive myocardial flow reserve (MFR) in diffuse coronary ectasia (DCE)

BJR|case reports ◽

10.1259/bjrcr.20190046 ◽

2020 ◽

Vol 6 (2) ◽

pp. 20190046

Author(s):

Mohammed Khalil ◽

Deniz Alibazoglu ◽

Cem Numan Balci ◽

Rawan Hussein ◽

Abraham Abuwadi ◽

...

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Myocardial Blood Flow ◽

Suspected Coronary Artery Disease ◽

Myocardial Flow Reserve ◽

Total Occlusion ◽

Flow Reserve ◽

Stress Myocardial Blood Flow ◽

Coronary Ectasia ◽

Myocardial Flow

Clinical use with evidence base for diagnostic and prognostic value of quantitative positron emission tomography(PET) myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease has exponentially increased over the last decade. This case illustrates the very first time that stress myocardial blood flow(MBF) in absolute terms (ml/min/gram) and myocardial flow reserve(MFR) are augmented in three vessel diffuse coronary ectasia by N13-Ammonia PET MPI. Moreover, relative qualitative MPI demonstrated moderate-sized ischemia in right coronary artery territory with chronic total occlusion in middle segment; despite regional myocardial flow reserve remains above ischemic thresholds while regional stress myocardial blood flow is mildly reduced.

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Comparison of the Prognostic Value of Global and Regional Myocardial Flow Capacity Radius, Myocardial Flow Reserve, and Stress Myocardial Blood Flow Using Rubidium-82 with SiPM PET/CT

10.21203/rs.3.rs-1122028/v1 ◽

2021 ◽

Author(s):

Matthieu DIETZ ◽

Christel H Kamani ◽

Gilles Allenbach ◽

Vladimir Rubimbura ◽

Stephane Fournier ◽

...

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Myocardial Flow Reserve ◽

Flow Capacity ◽

Flow Reserve ◽

Stress Myocardial Blood Flow ◽

Pet Ct ◽

Myocardial Flow ◽

Rubidium 82 ◽

Regional Myocardial Flow

Abstract Purpose The aim of this study was to assess the most reliable quantitative variable on Rubidium-82 (82Rb) cardiac PET/CT for predicting major adverse cardiovascular events (MACE), on the latest PET camera using silicon photomultipliers digital readout (SiPM) technology. Methods We prospectively enrolled 274 consecutive participants with suspected myocardial ischemia. Participants underwent 82Rb cardiac SiPM PET/CT and were followed-up for MACE over 652 days (interquartile range: 559 to 751 days). For each participant, global and regional myocardial flow reserve (MFR), stress myocardial blood flow (stress MBF) and their combination as myocardial flow capacity radius (MFC radius) were measured. Results On receiver operator curve analysis, MACE prediction was similar for global and regional MFR, stress MBF, and MFC radius (area under the curve; (i) Global: 0.70 vs. 0.71 and 0.73, and (ii) Regional: 0.71 vs. 0.71 and 0.73, respectively, p > 0.1 for all pairwise comparisons). On multivariable analysis, (i) Global: MFR < 1.98, stress MBF < 1.94 mL/g/min, and MFC radius < 3.12, as well as (ii) Regional: MFR < 1.75, stress MBF < 1.75 mL/g/min, and MFC radius < 2.7, emerged all as similar independent predictors of MACE (p < 0.001 for all). Conclusions Using the latest SiPM PET technology with 82Rb, global and regional MFR, stress MBF, and MFC radius are similar powerful predictors of cardiovascular event.

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Intra- and inter-operator repeatability of myocardial blood flow and myocardial flow reserve measurements using rubidium-82 pet and a highly automated analysis program

Journal of Nuclear Cardiology ◽

10.1007/s12350-010-9225-3 ◽

2010 ◽

Vol 17 (4) ◽

pp. 600-616 ◽

Cited By ~ 97

Author(s):

Ran Klein ◽

Jennifer M. Renaud ◽

Maria C. Ziadi ◽

Stephanie L. Thorn ◽

Andy Adler ◽

...

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Automated Analysis ◽

Myocardial Flow Reserve ◽

Analysis Program ◽

Flow Reserve ◽

Myocardial Flow ◽

Rubidium 82

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Reduced myocardial flow reserve in anatomically normal coronary arteries due to elevated baseline myocardial blood flow in men with old myocardial infarction

Journal of Nuclear Cardiology ◽

10.1067/mnc.2002.119687 ◽

2002 ◽

Vol 9 (1) ◽

pp. 62-67 ◽

Cited By ~ 3

Author(s):

K Yonekura

Keyword(s):

Myocardial Infarction ◽

Blood Flow ◽

Myocardial Blood Flow ◽

Coronary Arteries ◽

Myocardial Flow Reserve ◽

Normal Coronary Arteries ◽

Flow Reserve ◽

Old Myocardial Infarction ◽

Myocardial Flow

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Evaluation of Myocardial Blood Flow and Myocardial Flow Reserve by Radionuclide Imaging

Nuclear Cardiology ◽

10.1007/978-3-030-62195-7_3 ◽

2021 ◽

pp. 107-123

Author(s):

Raffaele Giubbini ◽

Elisa Milan

Keyword(s):

Blood Flow ◽

Myocardial Blood Flow ◽

Radionuclide Imaging ◽

Myocardial Flow Reserve ◽

Flow Reserve ◽

Myocardial Flow

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P6240The impact of stress myocardial blood flow as a very strong predictor for all-cause mortality, cardiovascular mortality and adverse cardiac and cerebrovascular event in hemodialysis population

European Heart Journal ◽

10.1093/eurheartj/ehz746.0841 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Umemoto ◽

S Ooshima ◽

M Katou ◽

H Kajiura ◽

S Inoue ◽

...

Keyword(s):

Risk Factors ◽

Blood Flow ◽

Myocardial Blood Flow ◽

Strong Predictor ◽

High Stress ◽

Cerebrovascular Event ◽

Net Reclassification Improvement ◽

Flow Reserve ◽

Stress Myocardial Blood Flow ◽

All Cause Mortality

Abstract Background In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic device for IHD. Although coronary flow reserve is the most important index in IHD diagnosis, there are limited data about stress myocardial blood flow (MBF). We investigated the prognosis predictability of stress MBF in all-cause mortality, cardiovascular (CV) mortality and adverse cardiac and cerebrovascular event (MACCE). Methods and results A total 438 of HD patients who undergone 13NH3PET for suspected IHD were enrolled. 29 cases were excluded due to revascularization therapy in 60 days. In total we collected 409 eligible cases. All patients were undergone13NH3PET at Nagoya Radiological Diagnosis Foundation. Patients were divided into two group according to the median value of stress MBF levels; low stress MBF group (<2.12) and high stress MBF group (≥2.12). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their all-cause mortality, CV mortality and MACCE. Kaplan-Meyer analysis shows that intergroup difference in all-cause mortality (log rank p=0.001, hazard ratio [HR] 0.411, 95% confident interval [CI] 0.261–0.632), CV mortality (log rank p=0.002, HR 0.324, 95% CI 0.157–0.625) and MACCE (log rank p<0.001, HR 0.465, 95% CI 0.324–0.657). Multiple cox analysis that include established risk factors shows CFR is an independent risk factor for all-cause mortality (HR 0.261, 95% CI 0.154–0.442), CV mortality (HR 0.172, 95% CI 0.079–0.374) and MACCE (HR 0.329, 95% CI 0.213–0.503). As a result of the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors, each indicator shows adding stress MBF on established risk factors improve the predictability in all-cause mortality, CV mortality and MACCE (all-cause mortality; NRI 0.642, p<0.001, IDI 0.091, p<0.001, CV mortality NRI 0.809, p<0.001, IDI 0.116, p<0.001, MACCE; NRI 0.646, p<0.001, IDI 0.072, p<0.001). Conclusion Considering prognosis of HD population, stress MBF is an important and independent predictor for all-cause mortality, CV mortality and MACCE. As a result of our investigation, stress MBF is one of most strong predictors in HD population.

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