Does coronary vasodilation after adenosine override endothelin-1-induced coronary vasoconstriction?

Endothelin-1 is a powerful coronary vasoconstrictor that is overexpressed in coronary artery disease. Adenosine is a powerful coronary vasodilator used for myocardial perfusion imaging to identify flow-limiting coronary artery stenosis. Therefore, in an animal model we tested the hypothesis that intracoronary endothelin-1 may cause myocardial perfusion abnormalities by positron emission tomography (PET) at resting conditions that may persist or only partially improve after intravenous adenosine stress in the absence of myocardial scar and flow-limiting stenosis. Fourteen dogs underwent serial PET perfusion imaging with rubidium-82 before and after subselective intracoronary infusion of endothelin-1, followed by intravenous and then intracoronary adenosine. Small physiological doses of endothelin-1 infused into the mid-left circumflex coronary artery caused quantitatively significant resting perfusion abnormalities that normalized after intracoronary adenosine but not consistently after intravenous adenosine used for diagnostic imaging. After effects of adenosine abated, resting perfusion defects returned, lasting up to 5 h in some animals. Cumulative doses of endothelin-1 caused perfusion defects that did not normalize after intravenous adenosine. In an animal model without myocardial scar or flow-limiting stenosis, intracoronary endothelin-1 causes visually apparent, quantitatively significant, long-lasting myocardial perfusion defects at resting conditions that may persist or only partially improve after intravenous adenosine used for diagnostic imaging. These results may potentially explain resting perfusion abnormalities or heterogeneity by clinical PET that may persist or only partially improve after adenosine stress perfusion imaging in the absence of myocardial scar and flow-limiting stenosis.

Mechanisms of progression and regression of coronary artery disease by PET related to treatment intensity and clinical events at long-term follow-up

Changes in regional myocardial perfusion throughout the entire coronary vascular tree, as opposed to changes in the worst regional perfusion defect, have not been described during long-term regression or progression of coronary artery disease (CAD) or related to clinical outcomes.

METHODS

Four-hundred nine patients with CAD undergoing dipyridamole PET at baseline and after 2.6 +/- 1.4 y were followed over 5 more years for coronary events. PET images were objectively quantified by automated software for changes in severity of the (i) baseline worst quadrant, indicating the worst flow-limiting stenosis at baseline PET; (ii) follow-up worst quadrant, indicating the worst stenosis on follow-up PET; and (iii) maximal change quadrant, indicating the largest change of any same quadrant pair from baseline-to-follow-up images.

RESULTS

At follow-up PET, new regional perfusion defects were seen in 40% of patients. In 77% of patients, the greatest change was in a quadrant different from the worst baseline defect. The maximal change quadrant improved in 70% of patients on intense lifestyle and pharmacologic lipid treatment, in 48% on moderate treatment, and in 39% on poor treatment (P < 0.0001). Combined quadrant changes integrated throughout the heart independently predicted cardiovascular events at long-term follow-up. In contrast, changes of any single baseline-to-follow-up quadrant pair did not.

CONCLUSION

By PET, 77% of patients with CAD had the greatest perfusion changes in areas different from the baseline worst perfusion defect and 40% had new perfusion defects. Changes in perfusion defects throughout the entire coronary vascular tree predicted coronary events, whereas changes in the worst flow-limiting stenosis at baseline or in any one segment of myocardium did not. To our knowledge, these data provide the first direct evidence on mechanisms for disproportionately greater reduction in cardiac events than changes in single stenosis severity with lipid treatment.

Positron Emission Tomography in the Routine Management of Coronary Artery Disease

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Clinical evaluation of a new concept: resting myocardial perfusion heterogeneity quantified by markovian analysis of PET identifies coronary microvascular dysfunction and early atherosclerosis in 1,034 subjects

Coronary endothelial dysfunction is an early marker of coronary artery disease (CAD) but its noninvasive assessment is limited. We tested the hypothesis that diffuse patchy heterogeneous resting myocardial perfusion by noninvasive cardiac PET, quantified objectively by Markovian homogeneity analysis, or its improvement during dipyridamole stress, is a predictor of even mild stress perfusion abnormalities, consistent with coronary microvascular dysfunction as an early marker of CAD.

METHODS

Rest-dipyridamole PET with (82)Rb was performed on 1,034 consecutive subjects for possible CAD or follow-up, for second opinion on revascularization procedures, or for screening because of risk factors and on 50 healthy control subjects. Objective, automated software quantified myocardial PET perfusion images for (i) patchy diffuse perfusion heterogeneity by Markovian homogeneity analysis separately from, independently of, and around significant localized regional perfusion defects; (ii) size and severity of localized regional perfusion defects caused by flow-limiting stenosis; and (iii) the graded base-to-apex longitudinal perfusion gradient due to early diffuse CAD without flow-limiting stenosis. History of vascular risk factors was obtained for all subjects.

RESULTS

Resting myocardial perfusion heterogeneity with a homogeneity index outside 1 SD of healthy reference subjects and its improvement with dipyridamole correlated closely with CAD documented by stress-induced regional myocardial perfusion abnormalities outside 1 SD independently of other risk factors by multivariate logistic regression analysis (P < 0.001), by multivariate linear regression analysis (P < 0.001), and by chi(2) analysis (P < 0.001). The relative odds ratios of having stress-induced myocardial perfusion abnormalities for a resting homogeneity index outside 1 SD of healthy reference subjects was highly predictive and substantially greater than for standard risk factors.

CONCLUSION

Patchy heterogeneous resting myocardial perfusion by noninvasive cardiac PET quantified objectively using Markovian homogeneity analysis, and its improvement after dipyridamole, are powerful independent predictors of even mild stress-induced perfusion abnormalities, more than standard risk factors, consistent with coronary microvascular dysfunction as an early marker of preclinical CAD for potential preventive treatment.

Novel insights into coronary lumen preservation during progression of coronary atherosclerosis in coronary atherosclerosis-prone rabbits

BACKGROUND

In coronary atherosclerosis-prone Watanabe heritable hyperlipidaemic (WHHLCA) rabbits, an animal model for low-density lipoprotein receptor deficiency and spontaneous coronary atherosclerosis, the coronary arteries show compensatory remodelling during the progression of atherosclerosis. Therefore, we analysed coronary remodelling of WHHLCA rabbits quantitatively using a method that eliminates the limitations of previous analytical methods.

METHODS

Arterial remodelling was evaluated in perfusion-fixed coronary arteries of 11 WHHLCA rabbits using both new and previous analyses. With the improved methods removing limitations on quantitative analysis of arterial remodelling, we evaluated how lumen area or arterial size changed with accumulating atherosclerotic plaques compared to before plaque development. The original lumen area before plaque development was calculated using the diameter-length relationship. Wall shear stress change ratio was calculated from changes in arterial size.

RESULTS

Using the old analytical method (and as seen in similar human studies), lumen area increased up to a level of 29% of cross-sectional narrowing. However, with the improved analysis, in cross-sectioning narrowing at levels below 10%, the lumen area modestly decreased, and when the cross-sectional narrowing ranged from 10-68%, the lumen area remained constant, and diminished sharply despite continued remodelling when cross-sectional narrowing reached 70% or above. Arterial remodelling progressed quantitatively to a slight increase in arterial wall shear stress as well as lumen area up to a level of 70% cross-sectional narrowing.

CONCLUSIONS

These findings demonstrate marked influences of arterial tapering and individual variation of arterial size on quantitative analysis of arterial remodelling, and provide the novel insight that coronary compensatory remodelling in atherosclerosis maintains the lumen size up to levels of 70% cross-sectional narrowing in proportion to wall shear stress.

Common artifacts in PET myocardial perfusion images due to attenuation-emission misregistration: clinical significance, causes, and solutions

Misregistration between attenuation and emission images causes artifactual abnormalities on cardiac PET images that result in false-positive defects. This study determines the frequency and mechanisms of misregistration artifacts, identifies their predictors, and validates a method for their routine clinical identification, prevention, or correction.

METHODS

We performed 1177 consecutive diagnostic myocardial perfusion PET studies using 1 of 3 protocols: (a). 3 initial consecutive measured attenuation correction (MAC) scans, followed by resting and dipyridamole emission scans; (b). an initial MAC scan (early MAC), followed by emission scans; and (c). a MAC attenuation scan obtained after emission scans (late MAC). Emission images were manually shifted to obtain coregistration with attenuation and reconstructed again using shifted emission data that eliminated artifactual defects. Measurements on PET images included heart size, heart and diaphragm displacement after dipyridamole, objective quantitative misregistration of attenuation and emission images, and size or severity of image defects before and after shifting emission images.

RESULTS

Of 1,177 rest-dipyridamole PET perfusion studies, 252 (21.4%) had artifactual defects due to attenuation-emission misregistration. By shifting emission images, quantitative severity and size of misregistration and artifactual defects significantly decreased (P < 0.001) with visual normalization. Artifactual defects were predicted by horizontal plane misregistration (odds ratio [OR] = 1.545, confidence intervals [CI] = 1.113-2.145, P = 0.009), body mass index (OR = 2.659, CI = 1.032-6.855, P = 0.043), and whole heart area in the horizontal plane at rest (OR = 1.096, CI = 1.018-1.179, P = 0.015). Quantitative misregistration was predicted by diaphragm displacement between rest and dipyridamole (P = 0.001, CI = 0.158-0.630), body mass index (P = 0.005, CI = 0.202-1.124), and whole heart area in the horizontal plane at rest (P = 0.004, CI = -0.144 to -0.028). Diaphragm displacement was significantly larger for obese compared with lean patients (P = 0.027) during the initial 10 min of the imaging protocol.

CONCLUSION

Misregistration of attenuation and emission images is common in cardiac PET imaging and causes artifactual defects predicted by diaphragmatic displacement, body mass index, and heart size. Multiattenuation imaging sequences and manual, visually optimized coregistration of attenuation and emission images substantially eliminate artifacts for reliably identifying mild perfusion defects of early nonobstructive coronary atherosclerosis as the basis for intense lifestyle and pharmacologic treatment.

Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease

OBJECTIVES

The purpose of this study was to determine if combined intense lifestyle and pharmacologic lipid treatment reduce myocardial perfusion abnormalities and coronary events in comparison to usual-care cholesterol-lowering drugs and whether perfusion changes predict outcomes.

BACKGROUND

Lifestyle and lipid drugs separately benefit patients with coronary artery disease (CAD).

METHODS

A total of 409 patients with CAD, who underwent myocardial perfusion imaging by dipyridamole positron emission tomography at baseline and after 2.6 years, had quantitative size/severity of perfusion defects measured objectively by automated software with follow-up for five additional years for coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction, or cardiac death. Patients were categorized blindly according to prospective, predefined criteria as "poor" treatment without diet or lipid drugs, or smoking; "moderate" treatment on American Heart Association diet and lipid-lowering drugs or on strict low-fat diet (<10% of calories) without lipid drugs; and "maximal" treatment with diet <10% of calories as fat, regular exercise, and lipid active drugs dosed to target goals of low-density lipoproteins <2.3 mmol/l (90 mg/dl), high-density lipoproteins >1.2 mmol/l (45 mg/dl), and triglycerides <1.1 mmol/l (100 mg/dl).

RESULTS

Over five years, coronary events occurred in 6.6%, 20.3%, and 30.6% of patients on maximal, moderate, and poor treatment, respectively (p = 0.001). Size/severity of perfusion abnormalities significantly decreased for patients receiving maximal treatment and increased for patients undergoing moderate and poor treatment (p = 0.003 and 0.0001, respectively). Combined intense lifestyle change plus lipid active drugs and severity/change of perfusion abnormalities independently predicted cardiac events.

CONCLUSIONS

Intense lifestyle and pharmacologic lipid treatment reduce size/severity of myocardial perfusion abnormalities and cardiac events compared with usual-care cholesterol-lowering drugs. Perfusion changes parallel treatment intensity and predict outcomes.

Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but "Normal" coronary angiography

BACKGROUND

Coronary arteries without focal stenosis at angiography are generally considered non-flow-limiting. However, atherosclerosis is a diffuse process that often remains invisible at angiography. Accordingly, we hypothesized that in patients with coronary artery disease, nonstenotic coronary arteries induce a decrease in pressure along their length due to diffuse coronary atherosclerosis.

METHODS AND RESULTS

Coronary pressure and fractional flow reserve (FFR), as indices of coronary conductance, were obtained from 37 arteries in 10 individuals without atherosclerosis (group I) and from 106 nonstenotic arteries in 62 patients with arteriographic stenoses in another coronary artery (group II). In group I, the pressure gradient between aorta and distal coronary artery was minimal at rest (1+/-1 mm Hg) and during maximal hyperemia (3+/-3 mm Hg). Corresponding values were significantly larger in group II (5+/-4 mm Hg and 10+/-8 mm Hg, respectively; both P<0.001). The FFR was near unity (0.97+/-0.02; range, 0.92 to 1) in group I, indicating no resistance to flow in truly normal coronary arteries, but it was significantly lower (0.89+/-0.08; range, 0.69 to 1) in group II, indicating a higher resistance to flow. In 57% of arteries in group II, FFR was lower than the lowest value in group I. In 8% of arteries in group II, FFR was <0.75, the threshold for inducible ischemia.

CONCLUSION

Diffuse coronary atherosclerosis without focal stenosis at angiography causes a graded, continuous pressure fall along arterial length. This resistance to flow contributes to myocardial ischemia and has consequences for decision-making during percutaneous coronary interventions.

The distribution of substance P and neuropeptide Y in four songbird species: a comparison of food-storing and non-storing birds

The distributions of the neuropeptides substance P (SP) and neuropeptide Y (NPY) were investigated in four songbird species that differ in their food-storing behavior. The food-storing black-capped chickadee (Parus atricapillus) was compared to the non-storing blue tit (Parus caeruleus) and great tit (Parus major) within the avian family Paridae, as well as to the non-storing dark-eyed junco (Junco hyemalis). All four species showed a similar distribution of SP throughout the brain with the exception of two areas, the hippocampal complex (including hippocampus (Hp) and parahippocampus (APH)) and the Wulst (including the hyperstriatum accessorium (HA)). SP-like immunoreactivity was found in cells of the Hp in juncos, but not in the three parid species. Two areas within the APH and HA showed SP-like immunoreactivity in all four species. The more medial of these (designated SPm) is a distinctive field of fibers and terminals found throughout the APH and extending into the HA. A positive relationship between SPm and Hp volume was found for all four species with the chickadee having a significantly larger SPm area relative to telencephalon than the other species. The distribution of SP in this region may be related to differences in food-storing behavior. In contrast to substance P, NPY distribution throughout the brain was similar in all four species. Further, NPY-immunoreactive cells were found in the Hp of all four species and no species differences in the number of NPY cells was observed.

Imaging of the endothelial dysfunction in coronary atherosclerosis

Coronary endothelial dysfunction is characterised by coronary vasoconstrictive responses to endothelium-dependent vasodilators. It is associated with coronary artery disease (CAD) and is considered an early phase of coronary atherosclerosis. Patients with CAD benefit from vigorous risk factor interventions and medical treatment, with a marked decrease in coronary events and an improvement in survival that are not reported following revascularisation procedures. Therefore, early detection of anatomical and functional changes in the coronary vasculature due to atherosclerosis provides the basis for integrated pharmacological, dietary and lifestyle modifications to prevent cardiovascular events and revascularisation procedures. The question arises as to whether these alterations in regional myocardial tone can be detected by any of the current non-invasive methods. Several methods are reviewed. We consider that intracoronary ultrasonography is the most accurate method, but non-invasive positron emission tomography and magnetic resonance imaging technology is of growing importance for identifying endothelial dysfunction of early coronary atherosclerosis.

Study of cyclin proteolysis in anaphase-promoting complex (APC) mutant cells reveals the requirement for APC function in the final steps of the fission yeast septation initiation network

Cytokinesis in eukaryotic cells requires the inactivation of mitotic cyclin-dependent kinase complexes. An apparent exception to this relationship is found in Schizosaccharomyces pombe mutants with mutations of the anaphase-promoting complex (APC). These conditional lethal mutants arrest with unsegregated chromosomes because they cannot degrade the securin, Cut2p. Although failing at nuclear division, these mutants septate and divide. Since septation requires Cdc2p inactivation in wild-type S. pombe, it has been suggested that Cdc2p inactivation occurs in these mutants by a mechanism independent of cyclin degradation. In contrast to this prediction, we show that Cdc2p kinase activity fluctuates in APC cut mutants due to Cdc13/cyclin B destruction. In APC-null mutants, however, septation and cutting do not occur and Cdc13p is stable. We conclude that APC cut mutants are hypomorphic with respect to Cdc13p degradation. Indeed, overproduction of nondestructible Cdc13p prevents septation in APC cut mutants and the normal reorganization of septation initiation network components during anaphase.

A precise, three-dimensional atlas of myocardial perfusion correlated with coronary arteriographic anatomy

To map precise myocardial perfusion anatomy, we correlated detailed coronary arteriographic anatomy for every coronary artery and all secondary branches in the heart that had flow-limiting stenosis with corresponding specific, circumscribed, myocardial perfusion defects by positron emission tomography. Eight hundred ninety-five patients with abnormal coronary arteriograms showing any visible coronary artery narrowing of greater than 10% diameter stenosis underwent positron emission tomography perfusion imaging at rest and after dipyridamole stress; the data obtained were processed automatically into 3-dimensional topographic displays of relative radionuclide uptake in anterior, septal, left lateral, and inferior quadrant views, without attenuation artifacts, depth-dependent resolution, or spatial distortion of polar displays. The selection criterion for detailed anatomic analysis was the presence of a discrete, localized, moderate to severe, dipyridamole-induced perfusion defect, defined by automated algorithms as 1 quadrant view outside 2 SDs of healthy control subjects with which a specific stenotic coronary artery and/or its secondary branches could be correlated unequivocally on the coronary arteriogram for mapping precise perfusion anatomy, not for determining sensitivity or specificity. Because the anatomy of myocardial perfusion is inherently not statistical data, the results are presented as a summary atlas and series of individual cases that illustrate myocardial perfusion anatomy. Because the patterns of myocardial perfusion anatomy were derived from a large number of subjects, the atlas provides generalized information, not previously published, that correlates detailed arteriographic anatomy with perfusion anatomy including secondary diagonal, marginal, and posterior descending branches of the coronary arteries.

Conserved Wat1/Pop3 WD-repeat protein of fission yeast secures genome stability through microtubule integrity and may be involved in mRNA maturation

Accurate chromosome segregation is dependent upon the integrity of mitotic spindles, which pull each pair of sister chromatids towards opposite poles. In this study, we have characterised fission yeast pop3-5235, a diploidising mutant that is impaired in genome stability. Pop3 is the same as Wat1, a conserved protein containing 7 WD repeats. Pop3/Wat1 has also been isolated from a two-hybrid screen as a binding partner to Prp2, the large subunit of the essential splicing factor U2AF. In wat1 mutants, the cellular amount of α-tubulin is decreased to very low levels, which results in compromised microtubules and spindles, consequently leading to unequal chromosome separation. Further analysis shows that, in spite of the binding between Wat1 and Prp2, Wat1 may not be involved directly in splicing reactions per se. Instead, we find that Wat1 is required for the maintenance of α-tubulin mRNA levels; moreover, transcript levels of genes other than the α-tubulin gene are also equally decreased in this mutant. Wild-type Wat1, but not the mutant protein, forms a large complex in the cell with several other proteins, suggesting that Wat1 functions as a structural linker in the complex. The results suggest that Wat1 plays a role in mRNA maturation as a coupling protein between splicing and synthesis and/or stabilisation.

Coordination between fission yeast glucan formation and growth requires a sphingolipase activity

css1 mutants display a novel defect in Schizosaccharomyces pombe cell wall formation. The mutant cells are temperature-sensitive and accumulate large deposits of material that stain with calcofluor and aniline blue in their periplasmic space. Biochemical analyses of this material indicate that it consists of alpha- and beta-glucans in the same ratio as found in cell walls of wild-type S. pombe. Strikingly, the glucan deposits in css1 mutant cells do not affect their overall morphology. The cells remain rod shaped, and the thickness of their walls is unaltered. Css1p is an essential protein related to mammalian neutral sphingomyelinase and is responsible for the inositolphosphosphingolipid-phospholipase C activity observed in S. pombe membranes. Furthermore, expression of css1(+) can compensate for loss of ISC1, the enzyme responsible for this activity in Saccharomyces cerevisiae membranes. Css1p localizes to the entire plasma membrane and secretory pathway; a C-terminal fragment of Css1p, predicted to encode a single membrane-spanning segment, is sufficient to direct membrane localization of the heterologous protein, GFP. Our results predict the existence of an enzyme(s) or process(es) essential for the coordination of S. pombe cell wall formation and division that is, in turn, regulated by a sphingolipid metabolite.

Fission yeast Clp1p phosphatase regulates G2/M transition and coordination of cytokinesis with cell cycle progression

BACKGROUND

In Saccharomyces cerevisiae the mitotic-exit network (MEN) functions in anaphase to promote the release of the Cdc14p phosphatase from the nucleolus. This release causes mitotic exit via inactivation of the cyclin-dependent kinase (Cdk). Cdc14p-like proteins are highly conserved; however, it is unclear if these proteins regulate mitotic exit as in S. cerevisiae. In Schizosaccharomyces pombe a signaling pathway homologous to the MEN and termed the septation initiation network (SIN) is required not for mitotic exit, but for initiation of cytokinesis and for a cytokinesis checkpoint that inhibits further cell cycle progression until cytokinesis is complete.

RESULTS

We have identified the S. pombe Cdc14p homolog, Clp1p, and show that it is not required for mitotic exit but rather functions together with the SIN in coordinating cytokinesis with the nuclear-division cycle. As cells enter mitosis, Clp1p relocalizes from the nucleolus to the spindle and site of cell division. Clp1p exit from the nucleolus does not depend on the SIN, but the SIN is required for keeping Clp1p out of the nucleolus until completion of cytokinesis. Clp1p, in turn, may promote the activation of the SIN by antagonizing Cdk activity until cytokinesis is complete and thus ensuring that cytokinesis is completed prior to the initiation of the next cell cycle. In addition to its roles in anaphase, Clp1p regulates the G2/M transition since cells deleted for clp1 enter mitosis precociously and cells overexpressing Clp1p delay mitotic entry. Unlike Cdc14p, Clp1p appears to antagonize Cdk activity by preventing dephosphorylation of Cdc2p on tyrosine.

CONCLUSIONS

S. pombe Clp1p affects cell cycle progression in a markedly different manner than its S. cerevisiae homolog, Cdc14p. This finding raises the possibility that related phosphatases in animal cells will prove to have important roles in coordinating the onset of cytokinesis with the events of mitosis.

Vectors and gene targeting modules for tandem affinity purification in Schizosaccharomyces pombe

We describe the construction of tagging cassettes and plasmids for tandem affinity purification (TAP) of proteins in Schizosaccharomyces pombe. The tagging cassettes are designed for either carboxy- or amino-terminal tagging of proteins. The carboxyl terminal tags differ in that they contain either two or four repeats of IgG binding units. For tagging endogenous loci, the cassettes contain the kan MX6 module to allow for selection of G418-resistant cells. The amino-terminal tagging vectors allow for the regulated expression of proteins. Sz. pombe Cdc2p was chosen to test these new affinity tags. Several known binding proteins co-purified with both Cdc2p-CTAP and N-TAP-Cdc2p, indicating the usefulness of these tags for the rapid purification of stable protein complexes from Sz. pombe.

Timing is everything: regulation of mitotic exit and cytokinesis by the MEN and SIN

Proper completion of mitosis requires careful coordination of numerous cellular events. It is crucial, for example, that cells do not initiate spindle disassembly and cytokinesis until chromosomes have been properly segregated. Cells have developed numerous safeguards or checkpoints to delay exit from mitosis and initiation of the next cell cycle in response to defects in late mitosis. In this review, we discuss recent work on two homologous signaling pathways in budding and fission yeast, termed the mitotic exit network (MEN) and septation initiation network (SIN), respectively, that are essential for coordinating completion of mitosis and cytokinesis with other mitotic events.

High prevalence of myocardial perfusion abnormalities on positron emission tomography in asymptomatic persons with a parent or sibling with coronary artery disease

BACKGROUND

We hypothesized that asymptomatic persons with a parent or sibling with coronary artery disease (CAD) have myocardial perfusion defects on positron emission tomography (PET) as markers of early CAD.

METHODS AND RESULTS

After medical and family histories were recorded, 90 subjects underwent rest-dipyridamole cardiac PET perfusion imaging, including 18 index cases (a subject with CAD documented by PET and arteriography), 32 asymptomatic adults without known CAD who had a parent or sibling with CAD among these index cases, 30 asymptomatic subjects with comparable coronary risk factors without CAD or a family history of CAD, and 10 volunteer control subjects with no risk factors and no family history. PET perfusion images were quantified with automated software for size of abnormalities as percent of the cardiac image outside 95% CIs of normal controls and for severity as the lowest quadrant average relative activity. Of asymptomatic subjects with a parent or sibling with CAD (first-degree relatives), 50% had dipyridamole-induced myocardial perfusion defects that involved >/=5% of the cardiac image outside normal 95% CIs with or without other risk factors. The size of perfusion defects was larger in first-degree relatives than in control subjects (11+/-13% versus 1+/-1%, P:=0.02) and larger than in asymptomatic subjects with comparable risk factors but no family history of CAD (11+/-13% versus 5+/-6%, P:=0.02).

CONCLUSIONS

This study documents the presence of quantitative, statistically significant, dipyridamole-induced myocardial perfusion abnormalities on PET in 50% of asymptomatic persons with a parent or sibling with CAD, independent of other risk factors, indicating preclinical coronary atherosclerosis.