scholarly journals Quantitative Cardiac Positron Emission Tomography: The Time Is Coming!

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-16 ◽  
Author(s):  
Roberto Sciagrà
Keyword(s):  
Positron Emission Tomography ◽  
Heart Disease ◽  
Hypertensive Heart Disease ◽  
Microvascular Dysfunction ◽  
Emission Tomography ◽  
Cardiac Pet ◽  
Cardiac Positron Emission Tomography ◽  
Quantitative Pet ◽  
Flow Reserve ◽  
Positron Emission

In the last 20 years, the use of positron emission tomography (PET) has grown dramatically because of its oncological applications, and PET facilities are now easily accessible. At the same time, various groups have explored the specific advantages of PET in heart disease and demonstrated the major diagnostic and prognostic role of quantitation in cardiac PET. Nowadays, different approaches for the measurement of myocardial blood flow (MBF) have been developed and implemented in user-friendly programs. There is large evidence that MBF at rest and under stress together with the calculation of coronary flow reserve are able to improve the detection and prognostication of coronary artery disease. Moreover, quantitative PET makes possible to assess the presence of microvascular dysfunction, which is involved in various cardiac diseases, including the early stages of coronary atherosclerosis, hypertrophic and dilated cardiomyopathy, and hypertensive heart disease. Therefore, it is probably time to consider the routine use of quantitative cardiac PET and to work for defining its place in the clinical scenario of modern cardiology.

Cardiac positron emission tomography (PET)

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Positron Emission Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Tomography ◽  
Emission Computed Tomography ◽  
Cardiac Pet ◽  
Clinical Tool ◽  
Cardiac Positron Emission Tomography ◽  
Positron Emission ◽  
Recent Developments

As in single photon emission computed tomography (SPECT), positron emission tomography (PET) involves the injection of a radiopharmaceutical, the physiological properties of which determine its distribution within the patient. The labelling radionuclide then allows this distribution to be imaged. The value of cardiac PET as a routine clinical tool, particularly for perfusion imaging, was previously limited by the expense and scarcity of cameras and the short half-lives of the radionuclides with complex radiochemistry. The need for an on-site cyclotron to produce these radiopharmaceuticals made a clinical service non-viable. A number of recent developments, however, have led to renewed interest in cardiac PET. This chapter covers PET instrumentation, detail on the radiopharmaceuticals used in cardiac PET, and a number of sections on F-fluorodeoxyglucose (F-FDG) PET covering infection and inflammation imaging.

scholarly journals Defining the prognostic value of [15O]H2O positron emission tomography derived myocardial ischemic burden

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.A Van Diemen ◽  
J.T Wijmenga ◽  
R.S Driessen ◽  
M.J Bom ◽  
S.P Schumacher ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Single Photon ◽  
Event Rate ◽  
Photon Emission ◽  
Emission Tomography ◽  
Emission Computed Tomography ◽  
Quantitative Pet ◽  
Flow Reserve ◽  
Positron Emission

Abstract Background A myocardial ischemic burden (IB) of 10% is used to denote high-risk patients with coronary artery disease (CAD). This threshold has primarily been assessed by single-photon emission computed tomography. Differences in the pharmacokinetics of the utilized traces, higher resolution of positron emission tomography (PET), and lastly differences in assessment of IB might lead to a higher prognostic threshold for quantitative PET. Purpose To determine a [15O]H2O PET derived IB to identify low (annualized event rate (AER) <1.0%) and high (AER ≥3%) risk CAD patients. Methods 623 patients who underwent [15O]H2O PET because of suspected CAD and in whom follow-up was obtained were included. The IB was defined as the percentage of myocardium with a hyperemic blood flow (hMBF) ≤2.3 ml/min/g and by a coronary flow reserve (CFR) of ≤2.5. The endpoint was a composite of death and non-fatal myocardial infarction (MI). Time-dependent ROC curves were constructed for the prediction of the endpoint within the first 5-years, based on these curves thresholds were selected for which specificity was maximized and sensitivity was at least 80%. Patients were classified as having a high IB if their respective IBs were above the prognostic thresholds and as having a low IB if not. Results During a median follow-up of 6.7 years, 34 (6%) patients died and 28 (4%) experienced a MI resulting in 62 (10%) endpoints. An IB of 24% and 28% for hMBF and CFR, respectively, was found to be the optimal threshold to define prognosis. Patients with a high hMBF or high CFR IB had worse outcome compared to patients with a low IB (log-rank p<0.001 for both), with AERs of 0.6% vs. 2.8%, and 0.6% vs. 2.4% (p<0.001 for both), respectively. Patients with a concordantly high hMBF and CFR derived IB had the worst outcome (AER: 3.1%), whereas patients with a concordantly low or discordant IB result had a similarly low event rate of 0.5% and 0.9% (p=0.953), respectively (log-rank p=0.445). A concordantly high hMBF and CFR IB was an independent predictor of adverse outcome beyond clinical characteristics (adjusted hazard ratio: 3.52, p<0.001). Conclusion An IB of 24% and 28% for hMBF and CFR was found to be the optimal prognostic threshold. Both measurements can be used to determine patients outcome. However combining hMBF and CFR IB results leads to a further refinement of risk-stratification allowing for the identification of low (concordant low or discordant IB result) and high (concordant high IB result) risk CAD patients. Funding Acknowledgement Type of funding source: None

Abstract 5636: Major Depression is Associated with Decreased Coronary Flow Reserve Detected by Positron Emission Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Viola Vaccarino ◽  
J D Bremner ◽  
John Votaw ◽  
Tracy Faber ◽  
Emir Veledar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Positron Emission Tomography ◽  
Myocardial Perfusion ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Microvascular Dysfunction ◽  
Emission Tomography ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Positron Emission

Introduction. Major depressive disorder (MDD) is associated with coronary heart disease, but the underlying mechanisms are unclear. Coronary flow reserve (CFR) in response to adenosine is an index of coronary microvascular dysfunction which predisposes to myocardial ischemia. We examined the relationship between MDD and CFR in a genetically informative sample. Methods. We studied 141 twin pairs drawn from the Vietnam Era Twin Registry who were born between 1946 and 1956 (mean age 54). For all twins, a lifetime history of MDD was determined with the Structured Clinical Interview for Psychiatry Disorders; 53 pairs were discordant for MDD and 88 pairs were free of MDD. Standard cardiovascular risk factors were obtained by interview and examination. We performed myocardial perfusion imaging and blood flow quantitation with [13N] ammonia positron emission tomography at rest and after adenosine stress. A perfusion defect score summed the number and severity of defects across 20 myocardial regions. CFR was measured as the ratio of maximum flow to baseline flow at rest. Mixed-effect and GEE models were used to conduct matched-pair analyses. Results. There was no difference in the distribution of abnormal scans, in summed rest or stress defect scores, and in heart rate/blood pressure responses to adenosine between twins with and without MDD. Among the DZ twin pairs discordant for MDD, the mean CFR was lower in twins with MDD than their brothers without MDD (2.36 ± 0.66 vs 2.75 ± 0.90; p=0.03); no significant difference in mean CFR was found in MZ discordant pairs (2.90±0.78 vs 2.64±0.64, p=0.13). The zygosity by MDD interaction was significant (p=0.01). Results did not change substantially after adjusting for cardiovascular disease risk factors and antidepressant use (adjusted interaction p=0.007). There were no differences in myocardial perfusion comparing twins in discordant pairs with twins in healthy pairs. Conclusions. MDD is associated with lower CFR in spite of no differences in visible perfusion defects, suggesting microvascular dysfunction. This association is largely due to shared genetic liability between depression and CFR, suggesting a common underlying pathophysiological process linking depression and coronary microvascular dysfunction. This research has received full or partial funding support from the American Heart Association, AHA National Center.

Cardiac positron emission tomography (PET)

2011 ◽  
Author(s):  
Nikant Sabharwal ◽  
Chee Yee Loong ◽  
Andrew Kelion
Keyword(s):  
Positron Emission Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
High Energy ◽  
Emission Tomography ◽  
Emission Computed Tomography ◽  
Cardiac Pet ◽  
Cardiac Positron Emission Tomography ◽  
Positron Emission ◽  
Pet Instrumentation

Introduction to cardiac positron emission tomography (PET) 212PET instrumentation (1) 214PET instrumentation (2) 216Radiopharmaceuticals for cardiac PET (1) 218Radiopharmaceuticals for cardiac PET (2) 220Interpretation and clinical significance of cardiac PET studies 222As in single photon emission computed tomography (SPECT), positron emission tomography (PET) involves the injection of a radiopharmaceutical, the physiological properties of which determine its distribution within the patient. The labelling radionuclide then allows this distribution to be imaged. In contrast to SPECT, the positron-emitting radionuclides used in PET produce pairs of high energy 511keV ...

Abstract 13781: Assessment of Microvascular Dysfunction by Transthoracic Echocardiography Compared to Positron Emission Tomography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Marie M Michelsen ◽  
Naja D Mygind ◽  
Adam A Pena ◽  
Rasmus H Olsen ◽  
Nis Høst ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Angina Pectoris ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Emission Tomography ◽  
Tissue Mass ◽  
Transthoracic Doppler Echocardiography ◽  
Flow Reserve ◽  
Positron Emission ◽  
N 93

Introduction: Microvessel dysfunction can be assessed by measurement of Coronary Flow Reserve (CFR) by Transthoracic Doppler Echocardiography (TTDE). Positron Emission Tomography (PET) is regarded as the gold standard for CFR measurements. Only one previous study based on 10 healthy males has validated TTDE against PET measured CFR. The aim of the study was to compare CFR measurements by TTDE to those obtained by PET in women with angina pectoris but no obstructive coronary artery disease (CAD). Methods: Patients (n=93) were randomly selected from a cohort of women with angina pectoris but no obstructive CAD and a successful CFR measurement by TTDE of the left anterior descending artery (LAD) during dipyridamole infusion (0.84 mg/kg). CFR was measured by rubidium-82 PET during adenosine infusion (0.84 mg/kg). A Quality Index (QI) of CFR measured by TTDE was assessed on a scale from 1-9 on the basis of visibility of vessel and characteristics of flow curves. Concordance between the methods was assessed by the Bland Altman method. Results: CFR was successfully measured in 88 women by rubidium PET (exclusion due to inability to complete examination (n=4) and one outlier with un-physiological high CFR value of 5.9). Median CFR (iq range) was 2.69 (2.24; 3.05) for PET and 2.36 (1.92; 2.75) for TTDE. CFR was systematically assessed higher by PET (mean difference 0.39, p<0.01. Reproducibility was compared to a large study (n=125) regarding PET-PET agreement (table 1). Conclusions: Results are similar to previous assessments of reproducibility of CFR assessed by PET. For patients with TTDE CFR QI > 6 there is a higher concordance between TTDE and PET CFR, indicating that the validity of CFR is dependent on quality. However, part of the divergence between PET and TTDE could be due to difference in method; TTDE estimates LAD flow velocities whereas PET estimates global flow per myocardial tissue mass. CFR measured with TTDE is a valid method to investigate cardiac microvascular dysfunction.

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