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Tamaki N, Manabe O. Current status and perspectives of nuclear cardiology. Ann Nucl Med 2024; 38:20-30. [PMID: 37891375 DOI: 10.1007/s12149-023-01878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Nuclear cardiology has long been used to identify myocardial ischemia for appropriate treatment strategies for stable coronary artery disease (CAD). After the Ischemia Trial, it is time to reevaluate the significance of ischemia assessment. Functional imaging continues to play pivotal role in detecting microcirculatory disturbances. PET provides a clear image of blood flow distribution and is useful for the quantitative evaluation of myocardial flow reserve (MFR), which plays an important role in predicting treatment strategies and improving prognosis in CAD. Heart failure has become a major area of focus in cardiovascular medicine. Radionuclide imaging has been widely applied in this field. FDG PET is useful in identifying cardiac sarcoidosis and active inflammation. Clinical values of I-123 MIBG and BMIPP SPECT have been reported worldwide from Japan. Additionally, clinical experiences of Tc-99m pyrophosphate imaging have recently gained attention for assessing cardiac amyloidosis. Cardiac PET/CT and PET/MR imaging permit combined assessment of metabolic/functional/structural analyses of various cardiac diseases. While other non-invasive imaging modalities have rapidly been developed, the roles of radionuclide imaging remain to be valuable for early and accurate diagnosis and patient management in most cases of chronic CAD and various cardiovascular diseases.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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2
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Yan M, Shang H, Hao L, Guo X, Zheng H, Li H, Zhao Y. A preliminary study of dobutamine myocardial flow reserve on 99mTc-Sestamibi CZT-SPECT. Ann Nucl Med 2023; 37:349-359. [PMID: 36892730 DOI: 10.1007/s12149-023-01829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND With improved resolution and sensitivity, the cadmium zinc telluride (CZT) detector measures myocardial blood flow (MBF) and myocardial flow reserve (MFR) via single photon emission computed tomography (SPECT). Recently, many studies have used vasodilator stress to obtain quantitative indexes. However, dobutamine used as a pharmaceutical stress has been rarely used to quantify myocardial perfusion using CZT-SPECT. Our study retrospectively analyzed the blood flow performance of 99mTc-Sestamibi (99mTc -MIBI) CZT-SPECT comparing dobutamine to adenosine. PURPOSE The study aims to explore whether dobutamine stress can be used for the myocardial perfusion quantitative analysis via CZT-SPECT as well as compare dobutamine MBF and MFR to adenosine. METHODS It was a retrospective study. A total of 68 patients with suspected or known coronary artery disease (CAD) were consecutively enrolled in this study. Thirty-four patients underwent dobutamine stress 99mTc-MIBI CZT-SPECT. Another thirty-four patients underwent adenosine stress 99mTc-MIBI CZT-SPECT. Patient characteristics, myocardial perfusion imaging (MPI) results, gated-myocardial perfusion imaging (G-MPI) results and quantitative analysis of MBF and MFR were collected. RESULTS In dobutamine stress group, stress MBF was significantly higher than rest MBF (median [interquartile range], 1.63 [1.46-1.94] vs. 0.89 [0.73-1.06], P < 0.001). In adenosine stress group, similar results were observed (median [interquartile range], 2.01 [1.34-2.20] vs. 0.88 [0.75-1.01], P < 0.001). When comparing the dobutamine and adenosine stress group, global MFR showed significant differences (median [interquartile range], the dobutamine group: 1.88 [1.67-2.38] vs. the adenosine group: 2.19 [1.87-2.64], P = 0.037). CONCLUSION MBF and MFR can be measured using dobutamine 99mTc -MIBI CZT-SPECT. In small sample single-center study, there was a difference in MFR produced by adenosine and dobutamine within the suspected or the known CAD population.
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Affiliation(s)
- Ming Yan
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hua Shang
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China.
| | - Luping Hao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Xiaorui Guo
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongming Zheng
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Hongmei Li
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
| | - Yuchan Zhao
- Department of Nuclear Medicine, The Second Hospital of Hebei Medical University, No. 215, Heping West Road, Xinhua District, Shijiazhuang, 050000, Hebei, China
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3
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Litmanovich D, Hurwitz Koweek LM, Ghoshhajra BB, Agarwal PP, Bourque JM, Brown RKJ, Davis AM, Fuss C, Johri AM, Kligerman SJ, Malik SB, Maroules CD, Meyersohn NM, Vasu S, Villines TC, Abbara S. ACR Appropriateness Criteria® Chronic Chest Pain-High Probability of Coronary Artery Disease: 2021 Update. J Am Coll Radiol 2022; 19:S1-S18. [PMID: 35550795 DOI: 10.1016/j.jacr.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Management of patients with chronic chest pain in the setting of high probability of coronary artery disease (CAD) relies heavily on imaging for determining or excluding presence and severity of myocardial ischemia, hibernation, scarring, and/or the presence, site, and severity of obstructive coronary lesions, as well as course of management and long-term prognosis. In patients with no known ischemic heart disease, imaging is valuable in determining and documenting the presence, extent, and severity of obstructive coronary narrowing and presence of myocardial ischemia. In patients with known ischemic heart disease, imaging findings are important in determining the management of patients with chronic myocardial ischemia and can serve as a decision-making tool for medical therapy, angioplasty, stenting, or surgery. This document summarizes the recent growing body of evidence on various imaging tests and makes recommendations for imaging based on the available data and expert opinion. This document is focused on epicardial CAD and does not discuss the microvascular disease as the cause for CAD. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Diana Litmanovich
- Harvard Medical School, Boston, Massachusetts; and Chief, Cardiothoracic imaging Section, Beth Israel Deaconess Medical Center.
| | - Lynne M Hurwitz Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina; Panel Chair ACR AUG committee
| | - Brian B Ghoshhajra
- Panel Vice-Chair, Division Chief, Cardiovascular Imaging, Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Prachi P Agarwal
- Division Director of Cardiothoracic Radiology and Co-Director of Congenital Cardiovascular MR Imaging, University of Michigan, Ann Arbor, Michigan
| | - Jamieson M Bourque
- Medical Director of Nuclear Cardiology and the Stress Laboratory, University of Virginia Health System, Charlottesville, Virginia; Nuclear cardiology expert
| | - Richard K J Brown
- University of Michigan Health System, Ann Arbor, Michigan; and Vice Chair of Clinical Operations, Department of Radiology and Imaging Sciences, University of Utah
| | - Andrew M Davis
- The University of Chicago Medical Center, Chicago, Illinois; American College of Physicians; and Associate Vice-Chair for Quality, Department of Medicine, University of Chicago
| | - Cristina Fuss
- Oregon Health & Science University, Portland, Oregon; SCCT Member of the Board; Section Chief Cardiothoracic Imaging Department of Diagnostic Radiology, Oregon Health & Science University; ABR OLA Cardiac Committee; and NASCI Program Vice-Chair
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada; Cardiology Expert; and ASE Board Member
| | | | - Sachin B Malik
- Division Chief Thoracic and Cardiovascular Imaging, Director of Cardiac MRI, Director of MRI, VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California
| | | | - Nandini M Meyersohn
- Fellowship Program Director, Massachusetts General Hospital, Boston, Massachusetts
| | - Sujethra Vasu
- Director, Cardiac MRI and Cardiac CT, Wake Forest University Health Sciences, Winston Salem, North Carolina; Society for Cardiovascular Magnetic Resonance
| | - Todd C Villines
- University of Virginia Health Center, Charlottesville, Virginia; Society of Cardiovascular Computed Tomography
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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Manabe O, Aikawa T, Naya M, Miura S, Oyama-Manabe N. Functional Assessment of Coronary Artery Disease by Myocardial Flow Reserve Versus Pressure-wire Based Assessment. ANNALS OF NUCLEAR CARDIOLOGY 2021; 7:57-62. [PMID: 36994131 PMCID: PMC10040938 DOI: 10.17996/anc.21-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
Positron emission tomography (PET) permits the noninvasive quantification of myocardial blood flow (MBF). Myocardial flow reserve (MFR), calculated by dividing stress MBF by rest MBF is a reliable index for the functional information of coronary artery disease. A pressure-derived physiological index, such as fractional flow reserve (FFR) is also an important measurement. Both MFR and FFR values are used to evaluate coronary physiology; however, but they are not interchangeable because each test has certain discrepancies. In this systematic review, we provide an overview of coronary physiology with PET compared to pressure-derived physiological indices.
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Affiliation(s)
- Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital
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5
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Hiroshima Y, Manabe O, Naya M, Tomiyama Y, Magota K, Obara M, Aikawa T, Oyama-Manabe N, Yoshinaga K, Hirata K, Kroenke M, Tamaki N, Katoh C. Quantification of myocardial blood flow with 11C-hydroxyephedrine dynamic PET: comparison with 15O-H 2O PET. J Nucl Cardiol 2020; 27:1118-1125. [PMID: 29270771 DOI: 10.1007/s12350-017-1140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND 11C-hydroxyephedrine (HED) PET has been used to evaluate the myocardial sympathetic nervous system (SNS). Here we sought to establish a simultaneous approach for quantifying both myocardial blood flow (MBF) and the SNS from a single HED PET scan. METHODS Ten controls and 13 patients with suspected cardiac disease were enrolled. The inflow rate of 11C-HED (K1) was obtained using a one-tissue-compartment model. We compared this rate with the MBF derived from 15O-H2O PET. In the controls, the relationship between K1 from 11C-HED PET and the MBF from 15O-H2O PET was linked by the Renkin-Crone model. RESULTS The relationship between K1 from 11C-HED PET and the MBF from 15O-H2O PET from the controls' data was approximated as follows: K1 = (1 - 0.891 * exp(- 0.146/MBF)) * MBF. In the validation set, the correlation coefficient demonstrated a significantly high relationship for both the whole left ventricle (r = 0.95, P < 0.001) and three coronary territories (left anterior descending artery: r = 0.96, left circumflex artery: r = 0.81, right coronary artery: r = 0.86; P < 0.001, respectively). CONCLUSION 11C-HED can simultaneously estimate MBF and sympathetic nervous function without requiring an additional MBF scan for assessing mismatch areas between MBF and SNS.
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Affiliation(s)
- Yuji Hiroshima
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan.
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuuki Tomiyama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Keiichiro Yoshinaga
- Diagnostic and Therapeutic Nuclear Medicine, National Institute of Radiological Science, Chiba, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
- Department of Nuclear Medicine, Klinikumrechts der Isar, Technical University of Munich, Munich, Germany
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Kita-Ku, Sapporo, 060-8638, Hokkaido, Japan
| | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Obara M, Naya M, Oyama-Manabe N, Aikawa T, Tomiyama Y, Sasaki T, Kikuchi Y, Manabe O, Katoh C, Tamaki N, Tsutsui H. Diagnostic value of quantitative coronary flow reserve and myocardial blood flow estimated by dynamic 320 MDCT scanning in patients with obstructive coronary artery disease. Medicine (Baltimore) 2018; 97:e11354. [PMID: 29979416 PMCID: PMC6076151 DOI: 10.1097/md.0000000000011354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We have developed the method for dynamic 320-row multidetector computed tomography (MDCT)-derived quantitative coronary flow reserve (CFRCT) and hyperemic myocardial blood flow (MBFCT). We evaluated diagnostic value of CFRCT and hyperemic MBFCT for detecting obstructive coronary artery disease (CAD) in per-patient and per-vessel analysis, and their relations with the severity of CAD burden.Adenosine stressed and rest dynamic myocardial perfusion MDCT were prospectively performed in patients with known or suspected CAD. Per-patient and per-vessel MBFCT were estimated from dynamic perfusion images in rest and hyperemic phases, and per-patient and per-vessel CFRCT were calculated from the ratio of rest and hyperemic MBFCT. Degree of stenosis was evaluated by coronary CT angiography (CTA) and invasive coronary angiography (ICA). Obstructive stenosis was defined as ≥70% stenosis in ICA. CAD burden with MDCT was calculated by logarithm transformed coronary artery calcium (CAC) score and the CTA-adapted Leaman risk score (CT-LeSc). A logistic regression analysis was used to measure the receiver-operating characteristic curve and corresponding area under the curve (AUC) for the detection of obstructive CAD.Twenty-seven patients and 81 vessels were eligible for this study. Sixteen patients had obstructive CAD, and 31 vessels had obstructive stenosis. Using an optimal cutoff, the CFRCT and hyperemic MBFCT had the moderate diagnostic values in per-patient (AUC = 0.89 and 0.86, respectively) and per-vessel (AUC = 0.79 and 0.76, respectively). Per-patient CFRCT and hyperemic MBFCT exhibited a moderate inverse correlation with CAC score and the CT-LeSc.Per-patient and per-vessel CFRCT as well as hyperemic MBFCT had moderate diagnostic value for detecting obstructive CAD. These per-patient values exhibited a moderate inverse correlation with CAD burden. CFRCT and hyperemic MBFCT might add quantitative functional information for evaluating patients with CAD.
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Affiliation(s)
- Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido Chuo Rosai Hospital, Iwamizawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yuuki Tomiyama
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine
| | | | - Yasuka Kikuchi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
- Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine
| | - Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine
| | - Chietsugu Katoh
- Faculty of Health Science, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido
| | - Nagara Tamaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan
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Manabe O, Naya M, Aikawa T, Obara M, Magota K, Kroenke M, Oyama-Manabe N, Hirata K, Shinyama D, Katoh C, Tamaki N. PET/CT scanning with 3D acquisition is feasible for quantifying myocardial blood flow when diagnosing coronary artery disease. EJNMMI Res 2017; 7:52. [PMID: 28585219 PMCID: PMC5459776 DOI: 10.1186/s13550-017-0296-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background The quantification of myocardial blood flow (MBF) and coronary flow reserve (CFR) are useful approaches for evaluating the functional severity of coronary artery disease (CAD). 15O-water positron emission tomography (PET) is considered the gold standard method for MBF quantification. However, MBF measurements in 15O-water PET with three-dimensional (3D) data acquisition, attenuation correction using computed tomography (CT), and time of flight have not been investigated in detail or validated. We conducted this study to evaluate the diagnostic potential of MBF measurements using PET/CT for a comparison of a control group and patients suspected of having CAD. Results Twenty-four patients with known or suspected CAD and eight age-matched healthy volunteers underwent rest and pharmacological stress perfusion studies with 15O-water PET/CT. The whole and three regional (left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) territory) MBF values were estimated. The CFR was computed as the ratio of the MBF during adenosine triphosphate-induced stress to the MBF at rest. The inter-observer variability was assessed by two independent observers. PET/CT using a 15O-water dose of 500 MBq and 3D data acquisition showed good image quality. A strong inter-observer correlation was detected in both the whole MBF analysis and the regional analysis with high intra-class correlation coefficients (r > 0.90, p < 0.001). Regional MBF at rest (LAD, 0.82 ± 0.15 ml/min/g; LCX, 0.83 ± 0.17 ml/min/g; RCA, 0.71 ± 0.20 ml/min/g; p = 0.74), MBF at stress (LAD, 3.77 ± 1.00 ml/min/g; LCX, 3.56 ± 1.01 ml/min/g; RCA, 3.27 ± 1.04 ml/min/g; p = 0.62), and CFR (LAD, 4.64 ± 0.90; LCX, 4.30 ± 0.64; RCA, 4.64 ± 0.96; p = 0.66) of the healthy volunteers showed no significant difference among the three regions. The global CFR of the patients was significantly lower than that of the volunteers (2.75 ± 0.81 vs. 4.54 ± 0.66, p = 0.0002). The regional analysis of the patients demonstrated that the CFR tended to be lower in the stenotic region compared to the non-stenotic region (2.43 ± 0.81 vs. 2.95 ± 0.92, p = 0.052). Conclusions 15O-water PET/CT with 3D data acquisition can be reliably used for the quantification of functional MBF and CFR in CAD patients.
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Affiliation(s)
- Osamu Manabe
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Tadao Aikawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masahiko Obara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Keiichi Magota
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Markus Kroenke
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Unal D, Gelincik A, Elitok A, Demir S, Olgac M, Coskun R, Kocaaga M, Colakoglu B, Buyukozturk S. Impact of high serum Immunoglobulin E levels on the risk of atherosclerosis in humans. Asia Pac Allergy 2017; 7:74-81. [PMID: 28487838 PMCID: PMC5410414 DOI: 10.5415/apallergy.2017.7.2.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Epidemiological studies show that immunoglobulin E (IgE) levels were higher in subjects with acute coronary events. However, it is unknown if the increased IgE level is a marker of future coronary incidents and whether it may be regarded as a risk factor of an ischemic heart disease. Objective Our aim was to investigate the relationship between IgE levels and some atherosclerotic markers in patients without known atherosclerotic disease. Methods Fifty patients (mean age, 40.96 ± 10.8 years) with high serum IgE levels due to various conditions who did not display evidence of an atherosclerotic disease and 30 healthy control subjects (mean age, 47 ± 8.27 years) were included in the study. Atherosclerotic disease markers including adhesion molecules like vascular cell adhesion molecule-1, intercellular adhesion molecule-1, proinflammatory cytokines such as interleukin-6, endothelin-1, and systemic inflammatory markers such as high sensitivity C-reactive protein were determined by enzyme-linked immunosorbent assay (ELISA). Endothelial functions of the coronary arteries were determined by coronary flow reserve (CFR) measurements and carotid intima media thickness using transthoracic Doppler echocardiography. Results CFR was significantly lower in the patient group when compared with the control group (p<0.001; 95% confidence interval, -0.79 to-0.20) while carotid media thicknesses were not different between 2 groups. There were no differences in ELISA test results between the 2 groups. Conclusion Our results showed that CFR as an early marker of endothelial dysfunction was significantly lower in patients with high IgE levels. This finding seems to support the role of IgE in the vascular pathology of atherosclerosis.
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Affiliation(s)
- Derya Unal
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Aslı Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Semra Demir
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Müge Olgac
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Mehmet Kocaaga
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Bahattin Colakoglu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34015, Turkey
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Tomiyama Y, Manabe O, Oyama-Manabe N, Naya M, Sugimori H, Hirata K, Mori Y, Tsutsui H, Kudo K, Tamaki N, Katoh C. Quantification of myocardial blood flow with dynamic perfusion 3.0 Tesla MRI: Validation with15o-water PET. J Magn Reson Imaging 2014; 42:754-62. [DOI: 10.1002/jmri.24834] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/10/2014] [Indexed: 01/11/2023] Open
Affiliation(s)
- Yuuki Tomiyama
- Department of Nuclear Medicine; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Osamu Manabe
- Department of Nuclear Medicine; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology; Hokkaido University Hospital; Sapporo Japan
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hiroyuki Sugimori
- Department of Diagnostic and Interventional Radiology; Hokkaido University Hospital; Sapporo Japan
| | - Kenji Hirata
- Department of Nuclear Medicine; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuki Mori
- Faculty of Health Sciences, Hokkaido University Graduate School of Health Sciences; Sapporo Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology; Hokkaido University Hospital; Sapporo Japan
| | - Nagara Tamaki
- Department of Nuclear Medicine; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Chietsugu Katoh
- Faculty of Health Sciences, Hokkaido University Graduate School of Health Sciences; Sapporo Japan
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Mekonnen G, Corban MT, Hung OY, Eshtehardi P, Eapen DJ, Al-Kassem H, Rasoul-Arzrumly E, Gogas BD, McDaniel MC, Pielak T, Thorball CW, Sperling L, Quyyumi AA, Samady H. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease. Atherosclerosis 2014; 239:55-60. [PMID: 25574858 DOI: 10.1016/j.atherosclerosis.2014.12.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/02/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Soluble urokinase-type plasminogen activator receptor (suPAR) is a novel biomarker released from leukocytes and endothelial cells that has been associated with atherosclerotic cardiovascular disease. We hypothesized that plasma suPAR level is an independent predictor of coronary microvascular function. METHODS Coronary blood flow velocity and plasma suPAR levels were evaluated in patients with non-obstructive coronary artery disease. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to basal average peak blood flow velocity and coronary microvascular dysfunction was defined as CFR ≤ 2.0 in the setting of a fractional flow reserve value of ≥0.75. Plasma suPAR levels were measured using ELISA technique. The association between suPAR and CFR was investigated using univariate and multivariate regression analyses. RESULTS In 66 patients, 47% were men, 26% had diabetes, 68% had hypertension and 76% had dyslipidemia. Mean age was 55 ± 12 years and median suPAR level 2.82 (2.08-3.40) ng/mL. Plasma suPAR levels correlated with age (r = 0.31, p = 0.01), body mass index (r = 0.25, p = 0.04) and high-sensitivity C-reactive protein (hs-CRP) (r = 0.33, p = 0.009). While median suPAR level was not significantly different in patients with different cardiovascular risk factors, patients on statin therapy had significantly higher suPAR level (p = 0.03). SuPAR correlated negatively with CFR and, after multivariate adjustment for established cardiovascular risk factors, medications profiles and hs-CRP, suPAR remained an independent predictor of CFR (B = -0.30, p = 0.04), indicating an independent association between suPAR level and coronary microvascular function. CONCLUSIONS In this cross-sectional study, plasma suPAR level was an independent predictor of coronary microvascular function. Larger prospective clinical trials are warranted to investigate the prognostic value of this novel biomarker and the role of immune dysregulation in coronary microvascular disease.
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Affiliation(s)
- Girum Mekonnen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michel T Corban
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Olivia Y Hung
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Parham Eshtehardi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Danny J Eapen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Hatem Al-Kassem
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Emad Rasoul-Arzrumly
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Bill D Gogas
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael C McDaniel
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Tomasz Pielak
- Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Laurence Sperling
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Naya M, Tamaki N, Tsutsui H. Coronary flow reserve estimated by positron emission tomography to diagnose significant coronary artery disease and predict cardiac events. Circ J 2014; 79:15-23. [PMID: 25744627 DOI: 10.1253/circj.cj-14-1060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary artery disease (CAD) is a major cause of death in Japan. Coronary angiography is useful to assess the atherosclerotic burden in CAD patients, but its ability to predict whether patients will respond favorably to optimal medical therapy and revascularization is limited. The measurement of the fractional flow reserve with angiography is a well-validated method for identifying ischemic vessels. However, neither an anatomical assessment nor a functional assessment can delineate microvasculature or estimate its function. The quantitative coronary flow reserve (CFR) estimated from sequential myocardial perfusion images obtained by positron emission tomography (PET) during stress provides an accurate index of hyperemic reactivity to vasodilatory agents in the myocardium. In fact, there is growing evidence that the CFR reflects disease activity in the entire coronary circulation, including epicardial coronary artery stenosis, diffuse atherosclerosis, and microvascular dilatory function. Importantly, reduced CFR is observed even in patients without flow-limiting coronary stenosis, and its evaluation can improve the risk stratification of patients at any stage of CAD. This review focuses on the application of CFR estimated by cardiac PET for the diagnosis and risk stratification of patients with CAD.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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13
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Williams BA, Merhige ME. Comparing changes in severe versus mild perfusion defect size in patients who underwent serial rubidium-82 positron emission tomography myocardial perfusion imaging. Am J Cardiol 2014; 114:1512-7. [PMID: 25260944 DOI: 10.1016/j.amjcard.2014.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022]
Abstract
Serial myocardial perfusion imaging (MPI) is valuable for assessing coronary disease progression and treatment efficacy. Previous serial MPI studies emphasized severe perfusion defects, with no attention given to milder perfusion defects. Thus, this study sought to compare and identify predictors of change in severe versus mild perfusion defect size in patients who underwent serial positron emission tomography (PET) MPI. Serial PET MPI was performed in 551 patients with an average of 1.9 years between scans. Severe and mild perfusion defect size at both PETs were derived from automated software as percentage of left ventricular mass with relative tracer activity <60% (severe) and between 61% and 80% of maximum tracer activity (mild), respectively. Predictors of change in severe and mild perfusion defect size between PETs were determined. Overall, severe perfusion defect sizes improved (p <0.001) and mild perfusion defect sizes worsened (p <0.001) between PETs with individual changes being highly variable. In individuals with negligible changes in severe defect size (±2%), changes in mild defect size ranged from a worsening of 47% to an improvement of 48% of left ventricular mass. The strongest predictors of change in severe defect size were indicators of obstructive coronary disease including interval myocardial infarction, interval revascularization, history of myocardial infarction, and history of bypass surgery. Strong predictors of change in mild defect size were cardiac risk factors including male gender, body mass index, diabetes, and smoking. In conclusion, changes in mild perfusion defects may provide valuable secondary information for evaluating treatment efficacy in patients who underwent serial MPI.
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Affiliation(s)
- Brent A Williams
- Geisinger Health System, Danville, Pennsylvania; Coronary Disease Reversal and Prevention Center, Tonawanda, New York.
| | - Michael E Merhige
- Coronary Disease Reversal and Prevention Center, Tonawanda, New York
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14
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Improved spillover correction model to quantify myocardial blood flow by 11C-acetate PET: comparison with 15O-H 2O PET. Ann Nucl Med 2014; 29:15-20. [PMID: 25209232 DOI: 10.1007/s12149-014-0904-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE (11)C-acetate has been applied for evaluation of myocardial oxidative metabolism and can simultaneously estimate myocardial blood flow (MBF). We developed a new method using two-parameter spillover correction to estimate regional MBF (rMBF) with (11)C-acetate PET in reference to MBF derived from (15)O-H2O PET. The usefulness of our new approach was evaluated compared to the conventional method using one-parameter spillover correction. METHODS Sixty-three subjects were examined with (11)C-acetate and (15)O-H2O dynamic PET at rest. Inflow rate of (11)C-acetate (K1) was compared with MBF derived from (15)O-H2O PET. For the derivation, the relationship between K1 and MBF from (15)O-H2O was linked by the Renkin-Crone model in 20 subjects as a pilot group. One-parameter and two-parameter corrections were applied to suppress the spillover between left ventricular (LV) wall and LV cavity. Validation was set using the other 43 subjects' data. Finally, rMBFs were calculated using relational expression derived from the pilot-group data. RESULTS The relationship between K1 and MBF derived from (15)O-H2O PET was approximated as K1 = [1-0.764 × exp(-1.001/MBF)] MBF from the pilot data using the two-parameter method. In the validation set, the correlation coefficient between rMBF from (11)C-acetate and (15)O-H2O demonstrated a significantly higher relationship with the two-parameter spillover correction method than the one-parameter spillover correction method (r = 0.730, 0.592, respectively, p < 0.05). CONCLUSION In (11)C-acetate PET study, the new two-parameter spillover correction method dedicated more accurate and robust myocardial blood flow than the conventional one-parameter method.
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Schindler TH, Quercioli A, Valenta I, Ambrosio G, Wahl RL, Dilsizian V. Quantitative Assessment of Myocardial Blood Flow—Clinical and Research Applications. Semin Nucl Med 2014; 44:274-93. [DOI: 10.1053/j.semnuclmed.2014.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Naya M, Murthy VL, Taqueti VR, Foster CR, Klein J, Garber M, Dorbala S, Hainer J, Blankstein R, Resnic F, Di Carli MF. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med 2014; 55:248-55. [PMID: 24408896 DOI: 10.2967/jnumed.113.121442] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Myocardial perfusion imaging has limited sensitivity for the detection of high-risk coronary artery disease (CAD). We tested the hypothesis that a normal coronary flow reserve (CFR) would be helpful for excluding the presence of high-risk CAD on angiography. METHODS We studied 290 consecutive patients undergoing (82)Rb PET within 180 d of invasive coronary angiography. High-risk CAD on angiography was defined as 2-vessel disease (≥ 70% stenosis), including the proximal left anterior descending artery; 3-vessel disease; or left main CAD (≥ 50% stenosis). Patients with prior Q wave myocardial infarction, elevated troponin levels between studies, prior coronary artery bypass grafting, a left ventricular ejection fraction of less than 40%, or severe valvular heart disease were excluded. RESULTS Fifty-five patients (19%) had high-risk CAD on angiography. As expected, the trade-off between the sensitivity and the specificity of the CFR for identifying high-risk CAD varied substantially depending on the cutoff selected. In multivariable analysis, a binary CFR of less than or equal to 1.93 provided incremental diagnostic information for the identification of high-risk CAD beyond the model with the Duke clinical risk score (>25%), percentage of left ventricular ischemia (>10%), transient ischemic dilation index (>1.07), and change in the left ventricular ejection fraction during stress (<2) (P = 0.0009). In patients with normal or slightly to moderately abnormal results on perfusion scans (<10% of left ventricular mass) during stress (n = 136), a preserved CFR (>1.93) excluded high-risk CAD with a high sensitivity (86%) and a high negative predictive value (97%). CONCLUSION A normal CFR has a high negative predictive value for excluding high-risk CAD on angiography. Although an abnormal CFR increases the probability of significant obstructive CAD, it cannot reliably distinguish significant epicardial stenosis from nonobstructive, diffuse atherosclerosis or microvascular dysfunction.
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Affiliation(s)
- Masanao Naya
- NonInvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Hybrid CT angiography and quantitative 15O-water PET for assessment of coronary artery disease: comparison with quantitative coronary angiography. Eur J Nucl Med Mol Imaging 2013; 40:1894-904. [DOI: 10.1007/s00259-013-2519-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 07/11/2013] [Indexed: 11/30/2022]
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18
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Bravo PE, Pinheiro A, Higuchi T, Rischpler C, Merrill J, Santaularia-Tomas M, Abraham MR, Wahl RL, Abraham TP, Bengel FM. PET/CT assessment of symptomatic individuals with obstructive and nonobstructive hypertrophic cardiomyopathy. J Nucl Med 2012; 53:407-14. [PMID: 22315440 DOI: 10.2967/jnumed.111.096156] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Patients with obstructive hypertrophic cardiomyopathy (HCM) exhibit elevated left ventricular outflow tract gradients (LVOTGs) and appear to have a worse prognosis than those with nonobstructive HCM. The aim of this study was to evaluate whether patients with obstruction, compared with nonobstructive HCM, demonstrate significant differences in PET parameters of microvascular function. METHODS PET was performed in 33 symptomatic HCM patients at rest and during dipyridamole stress (peak) for the assessment of regional myocardial perfusion (rMP), left ventricular ejection fraction (LVEF), myocardial blood flow (MBF), and myocardial flow reserve (MFR). Myocardial wall thickness and LVOTG were measured with an echocardiogram. Patients were divided into the following 3 groups: nonobstructive (LVOTG < 30 mm Hg at rest and after provocation test with amyl nitrite), obstructive (LVOTG ≥ 30 mm Hg at rest and with provocation), and latent HCM (LVOTG < 30 at rest but ≥ 30 mm Hg with provocation). RESULTS Eleven patients were classified as nonobstructive (group 1), 12 as obstructive (group 2), and 10 as latent HCM (group 3). Except for age (42 ± 18 y for group 1, 58 ± 7 y for group 2, and 58 ± 12 y for group 3; P = 0.01), all 3 groups had similar baseline characteristics, including maximal wall thickness (2.3 ± 0.5 cm for group 1, 2.2 ± 0.4 cm for group 2, and 2.1 ± 0.7 cm for group 3; P = 0.7). During peak flow, most patients in groups 1 and 2, but fewer in group 3, exhibited rMP defects (73% for group 1, 100% for group 2, and 40% for group 3; P = 0.007) and a drop in LVEF (73% for group 1, 92% for group 2, and 50% for group 3; P = 0.09). Peak MBF (1.58 ± 0.49 mL/min/g for group 1, 1.72 ± 0.46 mL/min/g for group 2, and 1.97 ± 0.32 mL/min/g for group 3; P = 0.14) and MFR (1.62 ± 0.57 for group 1, 1.90 ± 0.31 for group 2, and 2.27 ± 0.51 for group 3; P = 0.01) were lower in the nonobstructive and higher in the latent HCM group. LVOTGs demonstrated no significant correlation with any flow dynamics. In a multivariate regression analysis, maximal wall thickness was the only significant predictor for reduced peak MBF (β = -0.45, P = 0.003) and MFR (β = -0.63, P = 0.0001). CONCLUSION Maximal wall thickness was identified as the strongest predictor of impaired dipyridamole-induced hyperemia and flow reserve in our study, whereas outflow tract obstruction was not an independent determinant.
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Affiliation(s)
- Paco E Bravo
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
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Long-term smoking causes more advanced coronary endothelial dysfunction in middle-aged smokers compared to young smokers. Eur J Nucl Med Mol Imaging 2010; 38:491-8. [DOI: 10.1007/s00259-010-1647-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
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20
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Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging 2010; 3:623-40. [PMID: 20541718 DOI: 10.1016/j.jcmg.2010.04.007] [Citation(s) in RCA: 292] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future.
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Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology and Cardiac Imaging, Division of Cardiology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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21
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Coronary vasomotor function assessed by positron emission tomography. Eur J Nucl Med Mol Imaging 2009; 37:1213-24. [DOI: 10.1007/s00259-009-1311-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
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22
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Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia. Eur J Nucl Med Mol Imaging 2009; 37:368-76. [PMID: 19915835 DOI: 10.1007/s00259-009-1307-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. METHODS AND RESULTS Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 +/- 0.99 vs. 3.38 +/- 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. CONCLUSIONS The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension.
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Beanlands RSB, Ziadi MC, Williams K. Quantification of myocardial flow reserve using positron emission imaging the journey to clinical use. J Am Coll Cardiol 2009; 54:157-9. [PMID: 19573733 DOI: 10.1016/j.jacc.2009.03.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Rob S B Beanlands
- Molecular Function and Imaging Program, and National Cardiac PET Centre, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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24
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Cardiac positron emission tomography. J Am Coll Cardiol 2009; 54:1-15. [PMID: 19555834 DOI: 10.1016/j.jacc.2009.02.065] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 01/27/2009] [Accepted: 02/23/2009] [Indexed: 11/23/2022]
Abstract
Positron emission tomography (PET) is a powerful, quantitative imaging modality that has been used for decades to noninvasively investigate cardiovascular biology and physiology. Due to limited availability, methodologic complexity, and high costs, it has long been seen as a research tool and as a reference method for validation of other diagnostic approaches. This perception, fortunately, has changed significantly within recent years. Increasing diversity of therapeutic options for coronary artery disease, and increasing specificity of novel therapies for certain biologic pathways, has resulted in a clinical need for more accurate and specific diagnostic techniques. At the same time, the number of PET centers continues to grow, stimulated by PET's success in oncology. Methodologic advances as well as improved radiotracer availability have further contributed to more widespread use. Evidence for diagnostic and prognostic usefulness of myocardial perfusion and viability assessment by PET is increasing. Some studies suggest overall cost-effectiveness of the technique despite higher costs of a single study, because unnecessary follow-up procedures can be avoided. The advent of hybrid PET-computed tomography (CT), which enables integration of PET-derived biologic information with multislice CT-derived morphologic information, and the key role of PET in the development and translation of novel molecular-targeted imaging compounds, have further contributed to more widespread acceptance. Today, PET promises to play a leading diagnostic role on the pathway toward a future of high-powered, comprehensive, personalized, cardiovascular medicine. This review summarizes the state-of-the-art in current imaging methodology and clinical application, and outlines novel developments and future directions.
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TAMAKI N, YOSHINAGA K, KATOH C. Myocardial Perfusion PET:15O-labeled Water, 13N-labeled Ammonia, and 82Rb. ACTA ACUST UNITED AC 2009. [DOI: 10.3769/radioisotopes.58.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gimelli A, Marzullo P, LʼAbbate A, Rovai D. ‘False-positive’ myocardial perfusion imaging: correlation with cardiovascular risk factors and effect on event-free survival. J Cardiovasc Med (Hagerstown) 2008; 9:707-13. [DOI: 10.2459/jcm.0b013e3282f5ffc1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schindler TH, Zhang XL, Vincenti G, Mhiri L, Lerch R, Schelbert HR. Role of PET in the evaluation and understanding of coronary physiology. J Nucl Cardiol 2007; 14:589-603. [PMID: 17679069 PMCID: PMC1995749 DOI: 10.1016/j.nuclcard.2007.05.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology, Cardiovascular Center, University Hospital of Geneva, Geneva, Switzerland.
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Schindler TH, Zhang XL, Prior JO, Cadenas J, Dahlbom M, Sayre J, Schelbert HR. Assessment of intra- and interobserver reproducibility of rest and cold pressor test-stimulated myocardial blood flow with 13N-ammonia and PET. Eur J Nucl Med Mol Imaging 2007; 34:1178-88. [PMID: 17334762 DOI: 10.1007/s00259-007-0378-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 01/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE We investigated the intraobserver reproducibility of myocardial blood flow (MBF) measurements with PET at rest and during cold pressor test (CPT), and the interobserver agreement. METHODS Twenty normal volunteers were studied. Using (13)N-ammonia, MBF was measured at rest and during CPT and measurement was repeated in a 1-day session (short-term reproducibility; SR). After a follow-up of 2 weeks, MBF was measured again at rest and during CPT and compared with the initial baseline measurement (long-term reproducibility; LR). In addition, adenosine-induced hyperemic MBF increases were assessed. RESULTS Assessment of the SR did not show a significant absolute difference in MBF at rest, MBF during CPT or the endothelium-related change in MBF from rest to CPT (DeltaMBF) (0.09 +/- 0.10, 0.11 +/- 0.09, and 0.08 +/- 0.05 ml/g/min; p = NS), and they were linearly correlated (r = 0.72, r = 0.76 and r = 0.84; p < 0.0001). Corresponding values for standard error of the estimate (SEE), as indicative for the range of MBF measurement error, were 0.14, 0.14, and 0.09 ml/g/min. The LR yielded relatively higher but non-significant absolute differences in the MBF at rest, MBF during CPT and DeltaMBF (0.10 +/- 0.10, 0.14 +/- 0.10, and 0.19 +/- 0.10 ml/g/min; p = NS), and paired MBFs significantly correlated (r = 0.75, r = 0.71, and r = 0.60; p < 0.001). Corresponding SEEs were 0.13, 0.15, and 0.16 ml/g/min. The interobserver analysis yielded a high correlation for MBF at rest, MBF during CPT, and hyperemic MBF (r = 0.96, SEE=0.04; r = 0.78, SEE=0.11; and r = 0.87, SEE=0.28; p < 0.0001, respectively), and also a good interobserver correlation for DeltaMBF (r = 0.62, SEE=0.09; p < 0.003). CONCLUSION Short- and long-term MBF responses to CPT, as an index for endothelium-related coronary vasomotion, can be measured reproducibly with (13)N-ammonia PET. In addition, the high interobserver reproducibility for repeat analysis of MBF values suggests the measurements to be largely operator independent.
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Affiliation(s)
- Thomas H Schindler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095-1735, USA.
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Naya M, Tsukamoto T, Inubushi M, Morita K, Katoh C, Furumoto T, Fujii S, Tsutsui H, Tamaki N. Elevated Plasma Plasminogen Activator Inhibitor Type-1 is an Independent Predictor of Coronary Microvascular Dysfunction in Hypertension. Circ J 2007; 71:348-53. [PMID: 17322633 DOI: 10.1253/circj.71.348] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Elevated plasma plasminogen activator inhibitor-1 (PAI-1) is related to cardiovascular events, but its role in subclinical coronary microvascular dysfunction remains unknown. Thus, in the present study it was investigated whether elevated plasma PAI-1 activity is associated with coronary microvascular dysfunction in hypertensive patients. METHODS AND RESULTS Thirty patients with untreated essential hypertension and 10 age-matched healthy controls were studied prospectively. Myocardial blood flow (MBF) was measured by using (15)O-water positron emission tomography. Clinical variables associated with atherosclerosis (low-density lipoprotein-cholesterol, high-density lipoprotein (HDL)-cholesterol, triglyceride, homeostasis model assessment (HOMA-IR), and PAI-1 activity) were assessed to determine their involvement in coronary microvascular dysfunction. Adenosine triphosphate (ATP)-induced hyperemic MBF and coronary flow reserve (CFR) were significantly lower in hypertensive patients than in healthy controls (ATP-induced MBF: 2.77+/-0.82 vs 3.49+/-0.71 ml x g(-1) x min(-1); p<0.02 and CFR: 2.95 +/-1.06 vs 4.25+/-0.69; p<0.001). By univariate analysis, CFR was positively correlated with HDL-cholesterol (r=0.46, p<0.02), and inversely with HOMA-IR (r=-0.39, p<0.05) and PAI-1 activity (r=-0.61, p<0.001). By multivariate analysis, elevated PAI-1 activity remained a significant independent determinant of diminished CFR. CONCLUSIONS Elevated plasma PAI-1 activity was independently associated with coronary microvascular dysfunction, which suggests that plasma PAI-1 activity is an important clue linking hypofibrinolysis to the development of atherosclerosis.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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