1
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Somsen YBO, de Winter RW, Schumacher SP, van Veelen A, van Diemen PA, Jukema RA, Hoek R, Stuijfzand WJ, Danad I, Twisk JWR, Verouden NJ, Appelman Y, Nap A, Kleijn SA, Henriques JP, Knaapen P. Impact of sex on myocardial perfusion following percutaneous coronary intervention of chronic total coronary occlusions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 67:60-68. [PMID: 38658269 DOI: 10.1016/j.carrev.2024.04.014] [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: 01/13/2024] [Revised: 03/14/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES We sought to investigate the impact of sex on myocardial perfusion changes following chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) as measured by [15O]H2O positron-emission tomography (PET) perfusion imaging. BACKGROUND CTO PCI has been associated with an increase in myocardial perfusion, yet females are less likely to undergo revascularization. As such, data on the impact of sex on myocardial perfusion following CTO PCI is scarce. METHODS A total of 212 patients were prospectively enrolled and underwent CTO PCI combined with [15O]H2O PET perfusion imaging prior to and 3 months after PCI. Hyperemic myocardial blood flow (hMBF, mL·min-1·g-1) and coronary flow reserve (CFR) allocated to the CTO territory were quantitatively assessed. RESULTS This study comprised 34 (16 %) females and 178 (84 %) males. HMBF at baseline did not differ between sexes. Females showed a higher increase in hMBF than males (Δ1.34 ± 0.67 vs. Δ1.06 ± 0.74, p = 0.044), whereas post-PCI hMBF was comparable (2.59 ± 0.85 in females vs. 2.28 ± 0.84 in males, p = 0.052). Female sex was independently associated with a higher increase in hMBF after correction for clinical covariates. CFR increase after revascularization was similar in females and males (Δ1.47 ± 0.99 vs. Δ1.30 ± 1.14, p = 0.711). CONCLUSIONS The present study demonstrates a greater recovery of stress perfusion in females compared to males as measured by serial [15O]H2O PET imaging. In addition, a comparable increase in CFR was found in females and males. These results emphasize the benefit of performing CTO PCI in both sexes. CLINICAL PERSPECTIVE What is new? What are the clinical implications?
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Affiliation(s)
- Yvemarie B O Somsen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Anna van Veelen
- Department of Cardiology Amsterdam UMC, AMC, Amsterdam, the Netherlands.
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Roel Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Wynand J Stuijfzand
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Niels J Verouden
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Sebastiaan A Kleijn
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - José P Henriques
- Department of Cardiology Amsterdam UMC, AMC, Amsterdam, the Netherlands.
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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2
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Dahdal J, Jukema RA, Harms HJ, Cramer MJ, Raijmakers PG, Knaapen P, Danad I. PET myocardial perfusion imaging: Trends, challenges, and opportunities. J Nucl Cardiol 2024:102011. [PMID: 39067504 DOI: 10.1016/j.nuclcard.2024.102011] [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: 03/11/2024] [Revised: 06/25/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
Various non-invasive images are used in clinical practice for the diagnosis and prognostication of chronic coronary syndromes. Notably, quantitative myocardial perfusion imaging (MPI) through positron emission tomography (PET) has seen significant technical advancements and a substantial increase in its use over the past two decades. This progress has generated an unprecedented wealth of clinical information, which, when properly applied, can diagnose and fine-tune the management of patients with different types of ischemic syndromes. This state-of-art review focuses on quantitative PET MPI, its integration into clinical practice, and how it holds up at the eyes of modern cardiac imaging and revascularization clinical trials, along with future perspectives.
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Affiliation(s)
- Jorge Dahdal
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Hospital Del Salvador, Santiago, Chile
| | - Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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3
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Hoek R, van Diemen PA, Raijmakers PG, Driessen RS, Somsen YBO, de Winter RW, Jukema RA, Twisk JWR, Robbers LFHJ, van der Harst P, Saraste A, Lubberink M, Sörensen J, Knaapen P, Knuuti J, Danad I. Determining Hemodynamically Significant Coronary Artery Disease: Patient-Specific Cutoffs in Quantitative Myocardial Blood Flow Using [ 15O]H 2O PET Imaging. J Nucl Med 2024; 65:1113-1121. [PMID: 38724275 DOI: 10.2967/jnumed.123.267195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/08/2024] [Indexed: 07/03/2024] Open
Abstract
Currently, cutoffs of quantitative [15O]H2O PET to detect fractional flow reserve (FFR)-defined coronary artery disease (CAD) were derived from a single cohort that included patients without prior CAD. However, prior CAD, sex, and age can influence myocardial blood flow (MBF). Therefore, the present study determined the influence of prior CAD, sex, and age on optimal cutoffs of hyperemic MBF (hMBF) and coronary flow reserve (CFR) and evaluated whether cutoff optimization enhanced diagnostic performance of quantitative [15O]H2O PET against an FFR reference standard. Methods: Patients with chronic coronary symptoms underwent [15O]H2O PET and invasive coronary angiography with FFR. Optimal cutoffs for patients with and without prior CAD and subpopulations based on sex and age were determined. Results: This multicenter study included 560 patients. Optimal cutoffs were similar for patients with (n = 186) and without prior CAD (hMBF, 2.3 vs. 2.3 mL·min-1·g-1; CFR, 2.7 vs. 2.6). Females (n = 190) had higher hMBF cutoffs than males (2.8 vs. 2.3 mL·min-1·g-1), whereas CFRs were comparable (2.6 vs. 2.7). However, female sex-specific hMBF cutoff implementation decreased diagnostic accuracy as compared with the cutoff of 2.3 mL·min-1·g-1 (72% vs. 82%, P < 0.001). Patients aged more than 70 y (n = 79) had lower hMBF (1.7 mL·min-1·g-1) and CFR (2.3) cutoffs than did patients aged 50 y or less, 51-60 y, and 61-70 y (hMBF, 2.3-2.4 mL·min-1·g-1; CFR, 2.7). Age-specific cutoffs in patients aged more than 70 y yielded comparable accuracy to the previously established cutoffs (hMBF, 72% vs. 76%, P = 0.664; CFR, 80% vs. 75%, P = 0.289). Conclusion: Patients with and without prior CAD had similar [15O]H2O PET cutoffs for detecting FFR-defined significant CAD. Stratifying patients according to sex and age led to different optimal cutoffs; however, these values did not translate into an increased overall accuracy as compared with previously established thresholds for MBF.
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Affiliation(s)
- Roel Hoek
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yvemarie B O Somsen
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; and
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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4
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Møller MB, Linde JJ, Fuchs A, Køber LV, Nordestgaard BG, Kofoed KF. Normal values of myocardial blood flow measured with dynamic myocardial computed tomography perfusion. Eur Heart J Cardiovasc Imaging 2024; 25:986-995. [PMID: 38376985 DOI: 10.1093/ehjci/jeae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
AIMS Dynamic myocardial computed tomography (CT) perfusion (DM-CTP) can, in combination with coronary CT angiography (CCTA), provide anatomical and functional evaluation of coronary artery disease (CAD). However, normal values of myocardial blood flow (MBF) are needed to identify impaired myocardial blood supply in patients with suspected CAD. We aimed to establish normal values for MBF measured using DM-CTP, to assess the effects of age and sex, and to assess regional distribution of MBF. METHODS AND RESULTS A total of 82 healthy individuals (46 women) aged 45-78 years with normal coronary arteries by CCTA underwent either rest and adenosine stress DM-CTP (n = 30) or adenosine-induced stress DM-CTP only (n = 52). Global and segmental MBF were assessed. Global MBF at rest and during stress were 0.93 ± 0.42 and 3.58 ± 1.14 mL/min/g, respectively. MBF was not different between the sexes (P = 0.88 at rest and P = 0.61 during stress), and no correlation was observed between MBF and age (P = 0.08 at rest and P = 0.82 during stress). Among the 16 myocardial segments, significant intersegmental differences were found (P < 0.01), which was not related to age, sex, or coronary dominance. CONCLUSION MBF assessed by DM-CTP in healthy individuals with normal coronary arteries displays significant intersegmental heterogeneity which does not seem to be affected by age, sex, or coronary dominance. Normal values of MBF may be helpful in the clinical evaluation of suspected myocardial ischaemia using DM-CTP.
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Affiliation(s)
- Mathias B Møller
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Lars V Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Opgang 7, Herlev 2730, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
- Department of Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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5
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Jukema RA, de Winter RW, Hopman LHGA, Driessen RS, van Diemen PA, Appelman Y, Twisk JWR, Planken RN, Raijmakers PG, Knaapen P, Danad I. Impact of cardiac history and myocardial scar on increase of myocardial perfusion after revascularization. Eur J Nucl Med Mol Imaging 2023; 50:3897-3909. [PMID: 37561140 PMCID: PMC10611874 DOI: 10.1007/s00259-023-06356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue. METHODS Symptomatic patients underwent [15O]H2O positron emission tomography (PET) and FFR before and after revascularization. Patients with prior CAD, defined as prior MI or PCI, underwent scar quantification by magnetic resonance imaging late gadolinium enhancement. RESULTS Among 137 patients (87% male, age 62.2 ± 9.5 years) 84 (61%) had a prior MI or PCI. The increase in FFR and hyperemic myocardial blood flow (hMBF) was less in patients with prior MI or non-MI PCI compared to those without a cardiac history (FFR: 0.23 ± 0.14 vs. 0.20 ± 0.12 vs. 0.31 ± 0.18, p = 0.02; hMBF: 0.54 ± 0.75 vs. 0.62 ± 0.97 vs. 0.91 ± 0.96 ml/min/g, p = 0.04). Post-revascularization FFR and hMBF were similar across patients without a cardiac history or with prior MI or non-MI PCI. An increase in FFR was strongly associated to hMBF increase in patients without a cardiac history or with prior MI/non-MI PCI (r = 0.60 and r = 0.60, p < 0.01 for both). Similar results were found for coronary flow reserve. In patients with prior MI scar was negatively correlated to hMBF increase and independently predictive of an attenuated CFR increase. CONCLUSIONS Post revascularization FFR and perfusion were similar among patients without a cardiac history, with prior MI or non-MI PCI. In patients with prior MI scar burden was associated to an attenuated perfusion increase.
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Affiliation(s)
- Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yolande Appelman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R Nils Planken
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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6
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Slot S, Lavini C, Zwezerijnen GJC, Boden BJH, Marcus JT, Huisman MC, Yaqub M, Barbé E, Wondergem MJ, Zijlstra JM, Zweegman S, Raijmakers PG. Characterizing the Bone Marrow Environment in Advanced-Stage Myelofibrosis during Ruxolitinib Treatment Using PET/CT and MRI: A Pilot Study. Tomography 2023; 9:459-474. [PMID: 36960997 PMCID: PMC10037592 DOI: 10.3390/tomography9020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Current diagnostic criteria for myelofibrosis are largely based on bone marrow (BM) biopsy results. However, these have several limitations, including sampling errors. Explorative studies have indicated that imaging might form an alternative for the evaluation of disease activity, but the heterogeneity in BM abnormalities complicates the choice for the optimal technique. In our prospective diagnostic pilot study, we aimed to visualize all BM abnormalities in myelofibrosis before and during ruxolitinib treatment using both PET/CT and MRI. A random sample of patients was scheduled for examinations at baseline and after 6 and 18 months of treatment, including clinical and laboratory examinations, BM biopsies, MRI (T1-weighted, Dixon, dynamic contrast-enhanced (DCE)) and PET/CT ([15O]water, [18F]NaF)). At baseline, all patients showed low BM fat content (indicated by T1-weighted MRI and Dixon), increased BM blood flow (as measured by [15O]water PET/CT), and increased osteoblastic activity (reflected by increased skeletal [18F]NaF uptake). One patient died after the baseline evaluation. In the others, BM fat content increased to various degrees during treatment. Normalization of BM blood flow (as reflected by [15O]water PET/CT and DCE-MRI) occurred in one patient, who also showed the fastest clinical response. Vertebral [18F]NaF uptake remained stable in all patients. In evaluable cases, histopathological parameters were not accurately reflected by imaging results. A case of sampling error was suspected. We conclude that imaging results can provide information on functional processes and disease distribution throughout the BM. Differences in early treatment responses were especially reflected by T1-weighted MRI. Limitations in the gold standard hampered the evaluation of diagnostic accuracy.
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Affiliation(s)
- Stefanie Slot
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cristina Lavini
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gerben J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Bouke J H Boden
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Marc C Huisman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ellis Barbé
- Department of Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Mariëlle J Wondergem
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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7
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Jukema R, Maaniitty T, van Diemen P, Berkhof H, Raijmakers PG, Sprengers R, Planken RN, Knaapen P, Saraste A, Danad I, Knuuti J. Warranty period of coronary computed tomography angiography and [15O]H2O positron emission tomography in symptomatic patients. Eur Heart J Cardiovasc Imaging 2023; 24:304-311. [PMID: 36585755 DOI: 10.1093/ehjci/jeac258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 01/01/2023] Open
Abstract
AIMS Data on the warranty period of coronary computed tomography angiography (CTA) and combined coronary CTA/positron emission tomography (PET) are scarce. The present study aimed to determine the event-free (warranty) period after coronary CTA and the potential additional value of PET. METHOD AND RESULTS Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA and/or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD, or obstructive CAD. A hyperaemic myocardial blood flow (MBF) ≤ 2.3 mL/min/g was considered abnormal. The warranty period was defined as the time for which the cumulative event rate of death and non-fatal myocardial infarction (MI) was below 5%. Of 2575 included patients (mean age 61.4 ± 9.9 years, 41% male), 1319 (51.2%) underwent coronary CTA only and 1237 (48.0%) underwent combined coronary CTA/PET. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients with no CAD on coronary CTA was ≥10 years, whereas patients with non-obstructive CAD had a 5-year warranty period. Patients with obstructive CAD and normal hyperaemic MBF had a 2-year longer warranty period compared to patients with obstructive CAD and abnormal MBF (3 years vs. 1 year). CONCLUSION As standalone imaging, the warranty period for normal coronary CTA is ≥10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Normal PET yielded a 2-year longer warranty period in patients with obstructive CAD.
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Affiliation(s)
- Ruurt Jukema
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
| | - Pepijn van Diemen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Hans Berkhof
- Department of Epidemiology & Data Science, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ralf Sprengers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Heart Center, Turku University Hospital, Turku 20520, Finland
| | - Ibrahim Danad
- Department of Cardiology, Nuclear Medicine & PET Research, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.,Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku 20520, Finland.,Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital and University of Turku, Turku 20520, Finland
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8
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de Winter RW, Jukema RA, van Diemen PA, Schumacher SP, Driessen RS, Stuijfzand WJ, Everaars H, Bom MJ, van Rossum AC, van de Ven PM, Verouden NJ, Nap A, Raijmakers PG, Danad I, Knaapen P. The impact of coronary revascularization on vessel-specific coronary flow capacity and long-term outcomes: a serial [15O]H2O positron emission tomography perfusion imaging study. Eur Heart J Cardiovasc Imaging 2022; 23:743-752. [PMID: 34878102 PMCID: PMC9159743 DOI: 10.1093/ehjci/jeab263] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease (CAD). This study evaluated the effects of revascularization on CFC as assessed by serial [15O]H2O positron emission tomography (PET) perfusion imaging. METHODS AND RESULTS A total of 314 patients with stable CAD underwent [15O]H2O PET imaging at baseline and after myocardial revascularization to assess changes in hMBF, CFR, and CFC in 415 revascularized vessels. Using thresholds for ischaemia and normal perfusion, vessels were stratified in five CFC categories: myocardial steal, severely reduced CFC, moderately reduced CFC, minimally reduced CFC, and normal flow. Additionally, the association between CFC increase and the composite endpoint of death and non-fatal myocardial infarction (MI) was studied. Vessel-specific CFC improved after revascularization (P < 0.01). Furthermore, baseline CFC was an independent predictor of CFC increase (P < 0.01). The largest changes in ΔhMBF (0.90 ± 0.74, 0.93 ± 0.65, 0.79 ± 0.74, 0.48 ± 0.61, and 0.29 ± 0.66 mL/min/g) and ΔCFR (1.01 ± 0.88, 0.99 ± 0.69, 0.87 ± 0.88, 0.66 ± 0.91, and -0.01 ± 1.06) were observed in vessels with lower baseline CFC (P < 0.01 for both). During a median follow-up of 3.5 (95% CI 3.1-3.9) years, an increase in CFC was independently associated with lower rates of death and non-fatal MI (HR 0.43, 95% CI 0.19-0.98, P = 0.04). CONCLUSION Successful revascularization results in an increase in CFC. Furthermore, baseline CFC was an independent predictor of change in hMBF, CFR, and subsequently CFC. In addition, an increase in CFC was associated with a favourable outcome in terms of death and non-fatal MI.
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Affiliation(s)
- Ruben W de Winter
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ruurt A Jukema
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Wynand J Stuijfzand
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Niels J Verouden
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Kouchi T, Tanabe Y, Takemoto T, Yoshida K, Yamamoto Y, Miyazaki S, Fukuyama N, Nishiyama H, Inaba S, Kawaguchi N, Kido T, Yamaguchi O, Kido T. A Novel Quantitative Parameter for Static Myocardial Computed Tomography: Myocardial Perfusion Ratio to the Aorta. J Clin Med 2022; 11:jcm11071816. [PMID: 35407424 PMCID: PMC8999663 DOI: 10.3390/jcm11071816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/07/2023] Open
Abstract
We evaluated the feasibility of myocardial perfusion ratio to the aorta (MPR) in static computed tomography perfusion (CTP) for detecting myocardial perfusion abnormalities assessed by single-photon emission computed tomography (SPECT). Twenty-five patients with suspected coronary artery disease who underwent dynamic CTP and SPECT were retrospectively evaluated. CTP images scanned at a sub-optimal phase for detecting myocardial perfusion abnormalities were selected from dynamic CTP images and used as static CTP images in the present study. The diagnostic accuracy of MPR derived from static CTP was compared to those of visual assessment and conventional quantitative parameters such as myocardial CT attenuation (HU) and transmural perfusion ratio (TPR). The area under the curve of MPR (0.84; 95% confidence interval [CI], 0.76−0.90) was significantly higher than those of myocardial CT attenuation (0.73; 95% CI, 0.65−0.79) and TPR (0.76; 95% CI, 0.67−0.83) (p < 0.05). Sensitivity and specificity were 67% (95% CI, 54−77%) and 90% (95% CI, 86−92%) for visual assessment, 51% (95% CI, 39−63%) and 86% (95% CI, 82−89%) for myocardial CT attenuation, 63% (95% CI, 51−74%) and 84% (95% CI, 80−88%) for TPR, and 78% (95% CI, 66−86%) and 84% (95% CI, 80−88%) for MPR, respectively. MPR showed higher diagnostic accuracy for detecting myocardial perfusion abnormality compared with myocardial CT attenuation and TPR.
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Affiliation(s)
- Takanori Kouchi
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Yuki Tanabe
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
- Correspondence:
| | - Takumasa Takemoto
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Kazuki Yoshida
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Yuta Yamamoto
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Shigehiro Miyazaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Naoki Fukuyama
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Hikaru Nishiyama
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Naoto Kawaguchi
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Tomoyuki Kido
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (S.M.); (S.I.); (O.Y.)
| | - Teruhito Kido
- Department of Radiology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon 791-0295, Japan; (T.K.); (T.T.); (K.Y.); (Y.Y.); (N.F.); (H.N.); (N.K.); (T.K.); (T.K.)
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Thakker RA, Rodriguez Lozano J, Rodriguez Lozano P, Motiwala A, Rangasetty U, Khalife W, Chatila K. Coronary Microvascular Disease. Cardiol Ther 2022; 11:23-31. [PMID: 34993903 PMCID: PMC8933600 DOI: 10.1007/s40119-021-00250-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Indexed: 01/15/2023] Open
Abstract
Coronary microvascular disease or dysfunction (CMVD) has been associated with adverse cardiovascular outcomes. Despite a growing prevalence, guidelines on definitive treatment are lacking. Proposed mechanisms of endothelial dysfunction and resultant inflammation have been demonstrated as the underlying cause. Imaging modalities such as echocardiography, cardiac MRI, PET, and in some instances CT, have been shown to be useful in diagnosing CMVD mainly through assessment of coronary blood flow. Invasive measurements through thermodilution and pressure sensor-guided Doppler microcatheters have also been utilized. Treatment options are directed at targeting inflammatory pathways and angina. In our review, we highlight the current literature on the background of CMVD, diagnostic modalities, and management of this disease.
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Affiliation(s)
- Ravi A. Thakker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550 USA
| | | | | | - Afaq Motiwala
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX USA
| | | | - Wissam Khalife
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX USA
| | - Khaled Chatila
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX USA
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11
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Zhang X, Li H, Wu P, Yuan L, Wu Z, Liu H, Li S. The diagnosis and prognosis of coronary microvascular disease using PET/CT. Clin Hemorheol Microcirc 2021; 80:153-166. [PMID: 34958007 DOI: 10.3233/ch-201034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic and prognostic value of 13N-NH3·H2O positron emission tomography combined with computed tomography (PET/CT) for non-obstructive coronary microvascular disease (CMVD). METHODS A retrospective analysis was conducted on 70 patients with clinically suspected non-obstructive CMVD (35 males, 35 females) between March 2017 and August 2019. The average age of the patients was 53.32±7.82 years. The patients underwent 13N-NH3·H2O PET/CT and were divided into two groups based on diagnostic criteria: a CMVD group and a non-CMVD group. They were then followed up for 180-1,095 days. Data were analyzed using an χ 2 test, the logistic regression model, the multiple linear regression model, the Kaplan-Meier method, the Cox proportional hazards regression model, and a receiver operating characteristic (ROC) curve. RESULTS (1) The incidence of cardiovascular family history and a high calcification score (11-400) was higher in the CMVD group than in the non-CMVD group (58.8% vs. 20.8% and 29.4% vs. 5.7%, respectively; P < 0.05 for all), stress myocardial blood flow (MBF) and coronary flow reserve (CFR) values were lower in the CMVD group than in the non-CMVD group (2.280±0.693 vs. 3.641±1.365 and 2.142±0.339 vs. 3.700±1.123, respectively), and calcification score was higher in the CMVD group than in the non-CMVD group (110.18±165.07 vs. 13.21±41.68, respectively; P < 0.05 for all). Gender and diabetes were risk factors for stress MBF reduction (β= 1.287 and β= -0.636, respectively), calcification score and hypertension were risk factors for CFR reduction (β= -0.004 and β= -0.654, respectively), and hypertension, family history, and calcification score were risk factors in the CMVD group (OR = 7.323, OR = 5.108, OR = 1.012, respectively; P < 0.05 for all). (2) The prognosis of patients with CFR < 2.5 was worse than that of patients with CFR≥2.5 (x2 value: 27.404, P < 0.001). The risk of adverse cardiovascular events in diabetic patients was also increased (β= 0.328, P < 0.001). When CFR was set to 2.595, the prognostic sensitivity was 94% and the specificity was 80%. CONCLUSION The technology of 13N-NH3·H2O PET/CT can be used for the diagnosis and prognosis of non-obstructive CMVD. Cardiovascular risk factors are related to the occurrence and prognosis of CMVD.
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Affiliation(s)
- Xi Zhang
- Department of Nuclear Medicine, The Tumor Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Hui Li
- Department of Cardiology, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Ping Wu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Lin Yuan
- Department of PET/CT, The Tumor Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Zhifang Wu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Haiyan Liu
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Sijin Li
- Department of Nuclear Medicine, The First Hospital Affiliated to Shanxi Medical University, Taiyuan, China
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12
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Moody JB, Poitrasson-Rivière A, Hagio T, Buckley C, Weinberg RL, Corbett JR, Murthy VL, Ficaro EP. Added value of myocardial blood flow using 18F-flurpiridaz PET to diagnose coronary artery disease: The flurpiridaz 301 trial. J Nucl Cardiol 2021; 28:2313-2329. [PMID: 32002847 DOI: 10.1007/s12350-020-02034-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND 18F-Flurpiridaz is a promising investigational radiotracer for PET myocardial perfusion imaging with favorable properties for quantification of myocardial blood flow (MBF). We sought to validate the incremental diagnostic value of absolute MBF quantification in a large multicenter trial against quantitative coronary angiography. METHODS We retrospectively analyzed a subset of patients (N = 231) from the first phase 3 flurpiridaz trial (NCT01347710). Dynamic PET data at rest and pharmacologic stress were fit to a previously validated 2-tissue-compartment model. Absolute MBF and myocardial flow reserve (MFR) were compared with coronary artery disease severity quantified by invasive coronary angiography on a per-patient and per-vessel basis. RESULTS Stress MBF per-vessel accurately identified obstructive disease (c-index 0.79) and progressively declined with increasing stenosis severity (2.35 ± 0.71 in patients without CAD; 1.92 ± 0.49 in non-obstructed territories of CAD patients; and 1.54 ± 0.50 in diseased territories, P < 0.05). MFR similarly declined with increasing stenosis severity (3.03 ± 0.94; 2.69 ± 0.95; and 2.33 ± 0.86, respectively, P < 0.05). In multivariable logistic regression modeling, stress MBF and MFR provided incremental diagnostic value beyond patient characteristics and relative perfusion analysis. CONCLUSIONS Clinical myocardial blood flow measurement with 18F-flurpiridaz cardiac PET shows promise for routine application.
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Affiliation(s)
- Jonathan B Moody
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
| | | | - Tomoe Hagio
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
| | | | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James R Corbett
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Ficaro
- INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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13
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Mahmoud I, Dykun I, Kärner L, Hendricks S, Totzeck M, Al-Rashid F, Rassaf T, Mahabadi AA. Epicardial adipose tissue differentiates in patients with and without coronary microvascular dysfunction. Int J Obes (Lond) 2021; 45:2058-2063. [PMID: 34172829 PMCID: PMC8380538 DOI: 10.1038/s41366-021-00875-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Coronary microvascular dysfunction (CMD) is a common disorder, leading to symptoms similar to obstructive coronary artery disease and bears important prognostic implications. Local inflammation is suggested to promote development of CMD. Epicardial adipose tissue (EAT) is a local visceral fat depot surrounding the heart and the coronary arteries, modifying the inflammatory environment of the heart. We compared EAT in patients with and without CMD. METHODS We retrospectively included consecutive patients undergoing diagnostic coronary angiography as well as transthoracic echocardiography between March and October 2016. EAT thickness was defined as space between the epicardial wall of the myocardium and the visceral layer of the pericardium and EAT index was calculated as EAT thickness/body surface area. Logistic regression analysis was used to determine the association of EAT index with the presence of CMD. RESULTS Overall, 399 patients (mean age 60.2 ± 14.0 years, 46% male) were included. EAT thickness was significantly higher in patients with CMD compared to patients without CMD (EAT thickness 4.4 ± 1.8 vs. 4.9 ± 2.4 mm, p = 0,048 for patients without and with CMD, respectively). In univariate regression analysis, EAT index was associated with a 30% higher frequency of CMD (odds ratio [95% confidence interval]: 1.30 [1.001-1.69], p = 0.049). Effect sizes remained stable upon adjustment for body mass index (BMI, 1.30 [1.003-1.70], p = 0.048), but were attenuated when ancillary adjusting for age and gender (1.17 [0.90-1.54, p = 0.25). The effect was more pronounced in patients >65 years of age and independent of BMI and sex (1.85 [1.14-3.00], p = 0.013). CONCLUSION EAT thickness is independently associated with CMD and can differentiate between patients with and without CMD especially in older age groups. Our results support the hypothesis that modulation of local inflammation by epicardial fat is involved in the development of CMD.
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Affiliation(s)
- Ihab Mahmoud
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Iryna Dykun
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Luisa Kärner
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Stefanie Hendricks
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Matthias Totzeck
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Fadi Al-Rashid
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Tienush Rassaf
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
| | - Amir A. Mahabadi
- grid.410718.b0000 0001 0262 7331West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Clinic Essen, Essen, Germany
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Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: A 3-year serial hybrid [ 15O]H 2O PET/CT imaging study. Atherosclerosis 2020; 318:22-31. [PMID: 33450475 DOI: 10.1016/j.atherosclerosis.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion. METHODS Fifty-three patients (26% female) with de novo single-vessel coronary artery disease underwent [15O]H2O positron emission tomography/computed tomography at 1 month (baseline), 1 year, and 3 years after complete revascularization with percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH trial. RESULTS Baseline CAC score was 0 in 9%, 0.1-99.9 in 40%, 100-399.9 in 36% and ≥400 in 15% of patients, respectively. Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL min-1·g-1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p < 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time was not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years of follow-up. CONCLUSIONS Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.
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15
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EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2020; 48:1040-1069. [PMID: 33135093 PMCID: PMC7603916 DOI: 10.1007/s00259-020-05046-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.
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16
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Driessen RS, Bom MJ, van Diemen PA, Schumacher SP, Leonora RM, Everaars H, van Rossum AC, Raijmakers PG, van de Ven PM, van Kuijk CC, Lammertsma AA, Knuuti J, Ahmadi A, Min JK, Leipsic JA, Narula J, Danad I, Knaapen P. Incremental prognostic value of hybrid [15O]H2O positron emission tomography-computed tomography: combining myocardial blood flow, coronary stenosis severity, and high-risk plaque morphology. Eur Heart J Cardiovasc Imaging 2020; 21:1105-1113. [PMID: 32959061 PMCID: PMC7971168 DOI: 10.1093/ehjci/jeaa192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/25/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS This study sought to determine the prognostic value of combined functional testing using positron emission tomography (PET) perfusion imaging and anatomical testing using coronary computed tomography angiography (CCTA)-derived stenosis severity and plaque morphology in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS In this retrospective study, 539 patients referred for hybrid [15O]H2O PET-CT imaging because of suspected CAD were investigated. PET was used to determine myocardial blood flow (MBF), whereas CCTA images were evaluated for obstructive stenoses and high-risk plaque (HRP) morphology. Patients were followed up for the occurrence of all-cause death and non-fatal myocardial infarction (MI). During a median follow-up of 6.8 (interquartile range 4.8-7.8) years, 42 (7.8%) patients experienced events, including 23 (4.3%) deaths, and 19 (3.5%) MIs. Annualized event rates for normal vs. abnormal results of PET MBF, CCTA-derived stenosis, and HRP morphology were 0.6 vs. 2.1%, 0.4 vs. 2.1%, and 0.8 vs. 2.8%, respectively (P < 0.001 for all). Cox regression analysis demonstrated prognostic values of PET perfusion imaging [hazard ratio (HR) 3.75 (1.84-7.63), P < 0.001], CCTA-derived stenosis [HR 5.61 (2.36-13.34), P < 0.001], and HRPs [HR 3.37 (1.83-6.18), P < 0.001] for the occurrence of death or MI. However, only stenosis severity [HR 3.01 (1.06-8.54), P = 0.039] and HRPs [HR 1.93 (1.00-3.71), P = 0.049] remained independently associated. CONCLUSION PET-derived MBF, CCTA-derived stenosis severity, and HRP morphology were univariably associated with death and MI, whereas only stenosis severity and HRP morphology provided independent prognostic value.
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Affiliation(s)
- Roel S Driessen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Remi M Leonora
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis C van Kuijk
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Amir Ahmadi
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 E 69th Street, Suite 108, New York, NY 10021, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, 2775 Laurel St. Vancouver, BC V5Z 1M9, Canada
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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17
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Keulards DCJ, Fournier S, van 't Veer M, Colaiori I, Zelis JM, El Farissi M, Zimmermann FM, Collet C, De Bruyne B, Pijls NHJ. Computed tomographic myocardial mass compared with invasive myocardial perfusion measurement. Heart 2020; 106:1489-1494. [PMID: 32471907 PMCID: PMC7509389 DOI: 10.1136/heartjnl-2020-316689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
Objective The prognostic importance of a coronary stenosis depends on its functional severity and its depending myocardial mass. Functional severity can be assessed by fractional flow reserve (FFR), estimated non-invasively by a specific validated CT algorithm (FFRCT). Calculation of myocardial mass at risk by that same set of CT data (CTmass), however, has not been prospectively validated so far. The aim of the present study was to compare relative territorial-based CTmass assessment with relative flow distribution, which is closely linked to true myocardial mass. Methods In this exploratory study, 35 patients with (near) normal coronary arteries underwent CT scanning for computed flow-based CTmass assessment and underwent invasive myocardial perfusion measurement in all 3 major coronary arteries by continuous thermodilution. Next, the mass and flows were calculated as relative percentages of total mass and perfusion. Results The mean difference between CTmass per territory and invasively measured myocardial perfusion, both expressed as percentage of total mass and perfusion, was 5.3±6.2% for the left anterior descending territory, −2.0±7.4% for the left circumflex territory and −3.2±3.4% for the right coronary artery territory. The intraclass correlation between the two techniques was 0.90. Conclusions Our study shows a close relationship between the relative mass of the perfusion territory calculated by the specific CT algorithm and invasively measured myocardial perfusion. As such, these data support the use of CTmass to estimate territorial myocardium-at-risk in proximal coronary arteries.
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Affiliation(s)
- Daniëlle C J Keulards
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Stephane Fournier
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Iginio Colaiori
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Jo M Zelis
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Frederik M Zimmermann
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Carlos Collet
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Bernard De Bruyne
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.,Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Leopoldlaan, Belgium
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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18
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Maaniitty T, Knuuti J, Saraste A. 15O-Water PET MPI: Current Status and Future Perspectives. Semin Nucl Med 2020; 50:238-247. [PMID: 32284110 DOI: 10.1053/j.semnuclmed.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myocardial perfusion imaging with 15O-water positron emission tomography (PET) is a validated tool for quantitative measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Current scanner and software technology enable quantification of global and regional MBF in clinical PET myocardial perfusion imaging studies. Reduced stress MBF or MFR measured by 15O-water PET accurately detects hemodynamically significant coronary artery stenosis defined by intracoronary fractional flow reserve (FFR) measurement in patients with suspected obstructive coronary artery disease (CAD). Furthermore, MBF and MFR provide prognostic information on mortality and risk of myocardial infarction. Clinical experience in some centers indicates that clinical application of 15O-water PET in evaluation of CAD is feasible and guides management decisions on revascularization. This review discusses basic concepts of measuring MBF with 15O-water PET and reviews clinical studies on its application in evaluation of obstructive CAD.
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Affiliation(s)
- Teemu Maaniitty
- Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland; Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
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19
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Kuwahara N, Tanabe Y, Kido T, Kurata A, Uetani T, Ochi H, Kawaguchi N, Kido T, Ikeda S, Yamaguchi O, Asano M, Mochizuki T. Coronary artery stenosis-related perfusion ratio using dynamic computed tomography myocardial perfusion imaging: a pilot for identification of hemodynamically significant coronary artery disease. Cardiovasc Interv Ther 2019; 35:327-335. [PMID: 31630340 PMCID: PMC7497437 DOI: 10.1007/s12928-019-00627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to evaluate the feasibility of the stenosis-related quantitative perfusion ratio (QPR) for detecting hemodynamically significant coronary artery disease (CAD). Twenty-seven patients were retrospectively enrolled. All patients underwent dynamic myocardial computed tomography perfusion (CTP) and coronary computed tomography angiography (CTA) before invasive coronary angiography (ICA) measuring the fractional flow reserve (FFR). Coronary lesions with FFR ≤ 0.8 were defined as hemodynamically significant CAD. The myocardial blood flow (MBF) was calculated using dynamic CTP data, and CT-QPR was calculated as the CT-MBF relative to the reference CT-MBF. The stenosis-related CT-MBF and QPR were calculated using Voronoi diagram-based myocardial segmentation from coronary CTA data. The relationships between FFR and stenosis-related CT-MBF or QPR and the diagnostic performance of the stenosis-related CT-MBF and QPR were evaluated. Of 81 vessels, FFR was measured in 39 vessels, and 20 vessels (51%) in 15 patients were diagnosed as hemodynamically significant CAD. The stenosis-related CT-QPR showed better correlation (r = 0.70, p < 0.05) than CT-MBF (r = 0.56, p < 0.05). Sensitivity and specificity for detecting hemodynamically significant CAD were 95% and 58% for CT-MBF, and 95% and 90% for CT-QPR, respectively. The area under the receiver operating characteristic curve for the CT-QPR was significantly higher than that for the CT-MBF (0.94 vs. 0.79; p < 0.05). The stenosis-related CT-QPR derived from dynamic myocardial CTP and coronary CTA showed a better correlation with FFR and a higher diagnostic performance for detecting hemodynamically significant CAD than the stenosis-related CT-MBF.
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Affiliation(s)
- Natsumi Kuwahara
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuki Tanabe
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Akira Kurata
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hitomi Ochi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Migiwa Asano
- Department of Legal Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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20
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Stuijfzand WJ, Schumacher SP, Driessen RS, Lammertsma AA, Bakker AL, Rijnierse MT, van Rossum AC, van de Ven PM, Nap A, Appelman Y, van Royen N, van Leeuwen MA, Lemkes JS, Raijmakers PG, Knaapen P. Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2019; 12:967-979. [DOI: 10.1016/j.jcin.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
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21
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Al-Haddad R, Ismailani US, Rotstein BH. Current and Future Cardiovascular PET Radiopharmaceuticals. PET Clin 2019; 14:293-305. [DOI: 10.1016/j.cpet.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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22
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Stuijfzand WJ, Driessen RS, Raijmakers PG, Rijnierse MT, Maeremans J, Hollander MR, Lammertsma AA, van Rossum AC, Dens J, Nap A, van Royen N, Knaapen P. Prevalence of ischaemia in patients with a chronic total occlusion and preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2018; 18:1025-1033. [PMID: 27585716 DOI: 10.1093/ehjci/jew188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/11/2016] [Indexed: 01/21/2023] Open
Abstract
Aims Previous studies on invasive assessment of collateral function in patients with a chronic total occlusion (CTO) have displayed only a limited increase in collateral flow and high occurrence of coronary steal during pharmacological stress. This could question the necessity for ischaemia testing prior to revascularization of CTOs in the presence of myocardial viability. The purpose of the present study was to determine the prevalence of perfusion impairments in patients with a CTO as assessed by [15O]H2O positron emission tomography (PET). Methods and results Seventy-six consecutive patients (60 men, 62 ± 10 years) with a documented CTO and preserved left ventricular ejection fraction (LVEF) were included. All patients underwent PET to assess (hyperaemic) myocardial blood flow (MBF) and coronary flow reserve (CFR). Collateral connection score was 0 in 7 (9%), 1 in 13 (17%), and 2 in 56 (74%) of the cases, with predominantly a high Rentrop grade (96% ≥2). MBF of the target area during hyperaemia was significantly lower when compared with the remote area (1.37 ± 0.37 vs. 2.63 ± 0.71 mL min-1 g-1, P < 0.001). Target to remote ratio during hyperaemia was on average 0.54 ± 0.13, and 73 (96%) patients demonstrated a significantly impaired target to remote ratio (≤0.75). Only 7 (9%) patients displayed a preserved CFR of ≥2.50, whereas coronary steal (CFR <1.0) was observed in 10 (13%) patients. Conclusions Even in the presence of angiographically well-developed collateral arteries, the vast majority of CTO patients with a preserved LVEF showed significantly impaired perfusion. These results suggest that collateral function during increased blood flow demand in viable myocardium is predominantly insufficient.
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Affiliation(s)
- Wijnand J Stuijfzand
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Mischa T Rijnierse
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Maurits R Hollander
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jo Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt, Hasselt, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Alexander Nap
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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23
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Driessen RS, Danad I, Stuijfzand WJ, Schumacher SP, Knuuti J, Mäki M, Lammertsma AA, van Rossum AC, van Royen N, Raijmakers PG, Knaapen P. Impact of Revascularization on Absolute Myocardial Blood Flow as Assessed by Serial [
15
O]H
2
O Positron Emission Tomography Imaging. Circ Cardiovasc Imaging 2018; 11:e007417. [DOI: 10.1161/circimaging.117.007417] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/27/2018] [Indexed: 01/07/2023]
Abstract
Background:
The main goal of coronary revascularization is to restore myocardial perfusion in case of ischemia, causing coronary artery disease. Yet, little is known on the effect of revascularization on absolute myocardial blood flow (MBF). Therefore, the present prospective study assesses the impact of coronary revascularization on absolute MBF as measured by [
15
O]H
2
O positron emission tomography and fractional flow reserve (FFR) in patients with stable coronary artery disease.
Methods and Results:
Fifty-three patients (87% men, mean age 58.7±9.0 years) with suspected coronary artery disease were included prospectively. All patients underwent serial [
15
O]H
2
O positron emission tomography perfusion imaging at baseline and after revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. FFR was routinely measured at baseline and directly post-PCI. After revascularization, regional rest and stress MBF improved from 0.77±0.16 to 0.86±0.25 mL/min/g and from 1.57±0.59 to 2.48±0.91 mL/min/g, respectively, yielding an increase in coronary flow reserve from 2.02±0.69 to 2.94±0.94 (
P
<0.01 for all). Mean FFR at baseline improved post-PCI from 0.61±0.17 to 0.89±0.08 (
P
<0.01). After PCI, an increase in FFR paralleled improvement in absolute myocardial perfusion as reflected by stress MBF and coronary flow reserve (
r
= 0.74 and
r
= 0.71, respectively,
P
<0.01 for both). PCI demonstrated a greater improvement of regional stress MBF as compared with coronary artery bypass graft surgery (1.14±1.11 versus 0.66±0.69 mL/min/g, respectively,
P
=0.02). However, patients undergoing bypass grafting had a more advanced stage of coronary artery disease and more incomplete revascularizations.
Conclusion:
Successful coronary revascularization has a significant and positive impact on absolute myocardial perfusion as assessed by serial quantitative [
15
O]H
2
O positron emission tomography. Notably, improvement of FFR after PCI was directly related to the increase in hyperemic MBF.
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Affiliation(s)
- Roel S. Driessen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | - Ibrahim Danad
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | | | | | - Juhani Knuuti
- VU University Medical Center, Amsterdam, The Netherlands. Turku PET Centre, Turku University Hospital and University of Turku, Finland (J.K., M.M.)
| | - Maija Mäki
- VU University Medical Center, Amsterdam, The Netherlands. Turku PET Centre, Turku University Hospital and University of Turku, Finland (J.K., M.M.)
| | | | | | - Niels van Royen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | | | - Paul Knaapen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
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24
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Kitagawa K, Goto Y, Nakamura S, Takafuji M, Hamdy A, Ishida M, Sakuma H. Dynamic CT Perfusion Imaging: State of the Art. ACTA ACUST UNITED AC 2018. [DOI: 10.22468/cvia.2018.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kakuya Kitagawa
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yoshitaka Goto
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Satoshi Nakamura
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masafumi Takafuji
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Ahmed Hamdy
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
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25
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Guehl NJ, Normandin MD, Wooten DW, Rozen G, Ruskin JN, Shoup TM, Woo J, Ptaszek LM, Fakhri GE, Alpert NM. Rapid computation of single PET scan rest-stress myocardial blood flow parametric images by table look up. Med Phys 2017; 44:4643-4651. [PMID: 28594441 DOI: 10.1002/mp.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/11/2017] [Accepted: 05/31/2017] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We have recently reported a method for measuring rest-stress myocardial blood flow (MBF) using a single, relatively short, PET scan session. The method requires two IV tracer injections, one to initiate rest imaging and one at peak stress. We previously validated absolute flow quantitation in ml/min/cc for standard bull's eye, segmental analysis. In this work, we extend the method for fast computation of rest-stress MBF parametric images. METHODS We provide an analytic solution to the single-scan rest-stress flow model which is then solved using a two-dimensional table lookup method (LM). Simulations were performed to compare the accuracy and precision of the lookup method with the original nonlinear method (NLM). Then the method was applied to 16 single scan rest/stress measurements made in 12 pigs: seven studied after infarction of the left anterior descending artery (LAD) territory, and nine imaged in the native state. Parametric maps of rest and stress MBF as well as maps of left (fLV ) and right (fRV ) ventricular spill-over fractions were generated. Regions of interest (ROIs) for 17 myocardial segments were defined in bull's eye fashion on the parametric maps. The mean of each ROI was then compared to the rest (K1r ) and stress (K1s ) MBF estimates obtained from fitting the 17 regional TACs with the NLM. RESULTS In simulation, the LM performed as well as the NLM in terms of precision and accuracy. The simulation did not show that bias was introduced by the use of a predefined two-dimensional lookup table. In experimental data, parametric maps demonstrated good statistical quality and the LM was computationally much more efficient than the original NLM. Very good agreement was obtained between the mean MBF calculated on the parametric maps for each of the 17 ROIs and the regional MBF values estimated by the NLM (K1mapLM = 1.019 × K1ROINLM + 0.019, R2 = 0.986; mean difference = 0.034 ± 0.036 mL/min/cc). CONCLUSIONS We developed a table lookup method for fast computation of parametric imaging of rest and stress MBF. Our results show the feasibility of obtaining good quality MBF maps using modest computational resources, thus demonstrating that the method can be applied in a clinical environment to obtain full quantitative MBF information.
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Affiliation(s)
- Nicolas J Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Marc D Normandin
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Dustin W Wooten
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Guy Rozen
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Timothy M Shoup
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Jonghye Woo
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
| | - Nathaniel M Alpert
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-1107, USA
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26
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Guehl NJ, Normandin MD, Wooten DW, Rozen G, Sitek A, Ruskin J, Shoup TM, Ptaszek LM, El Fakhri G, Alpert NM. Single-scan rest/stress imaging: validation in a porcine model with 18F-Flurpiridaz. Eur J Nucl Med Mol Imaging 2017; 44:1538-1546. [PMID: 28365789 DOI: 10.1007/s00259-017-3684-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/17/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE 18F-labeled myocardial flow agents are becoming available for clinical application but the ∼2 hour half-life of 18F complicates their clinical application for rest-stress measurements. The goal of this work is to evaluate in a pig model a single-scan method which provides quantitative rest-stress blood flow in less than 15 minutes. METHODS Single-scan rest-stress measurements were made using 18F-Flurpiridaz. Nine scans were performed in healthy pigs and seven scans were performed in injured pigs. A two-injection, single-scan protocol was used in which an adenosine infusion was started 4 minutes after the first injection of 18F-Flurpiridaz and followed either 3 or 6 minutes later by a second radiotracer injection. In two pigs, microsphere flow measurements were made at rest and during stress. Dynamic images were reoriented into the short axis view, and regions of interest (ROIs) for the 17 myocardial segments were defined in bull's eye fashion. PET data were fitted with MGH2, a kinetic model with time varying kinetic parameters, in which blood flow changes abruptly with the introduction of adenosine. Rest and stress myocardial blood flow (MBF) were estimated simultaneously. RESULTS The first 12-14 minutes of rest-stress PET data were fitted in detail by the MGH2 model, yielding MBF measurement with a mean precision of 0.035 ml/min/cc. Mean myocardial blood flow across pigs was 0.61 ± 0.11 mL/min/cc at rest and 1.06 ± 0.19 mL/min/cc at stress in healthy pigs and 0.36 ± 0.20 mL/min/cc at rest and 0.62 ± 0.24 mL/min/cc at stress in the ischemic area. Good agreement was obtained with microsphere flow measurement (slope = 1.061 ± 0.017, intercept = 0.051 ± 0.017, mean difference 0.096 ± 0.18 ml/min/cc). CONCLUSION Accurate rest and stress blood flow estimation can be obtained in less than 15 min of PET acquisition. The method is practical and easy to implement suggesting the possibility of clinical translation.
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Affiliation(s)
- Nicolas J Guehl
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marc D Normandin
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dustin W Wooten
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Guy Rozen
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Arkadiusk Sitek
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeremy Ruskin
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Timothy M Shoup
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leon M Ptaszek
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathaniel M Alpert
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Assante R, Acampa W, Zampella E, Arumugam P, Nappi C, Gaudieri V, Panico M, Magliulo M, Tonge CM, Petretta M, Cuocolo A. Coronary atherosclerotic burden vs. coronary vascular function in diabetic and nondiabetic patients with normal myocardial perfusion: a propensity score analysis. Eur J Nucl Med Mol Imaging 2017; 44:1129-1135. [PMID: 28293706 DOI: 10.1007/s00259-017-3671-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE To assess the relationship between coronary atherosclerotic burden and vascular function in diabetic and nondiabetic patients after balancing for coronary risk factors. METHODS We studied 672 patients without overt coronary artery disease and normal myocardial perfusion on stress 82Rb PET/CT imaging. To account for differences in baseline characteristics between diabetic patients and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables and coronary risk factors. RESULTS Before matching, diabetic patients had higher coronary artery calcium (CAC) scores (p < 0.001) and lower coronary flow reserve (CFR; p < 0.001) than nondiabetic patients. After matching, CAC scores were comparable between diabetic and nondiabetic patients, but diabetic patients still had lower hyperaemic myocardial blood flow (p < 0.001) and CFR (p < 0.05). Patients were categorized by ln(CAC score) quartiles. There was a decrease in CFR with increasing CAC score quartile in both diabetic patients (p for trend < 0.01) and nondiabetic patients (p for trend < 0.005). Diabetes was associated with lower CFR across quartile categories (p < 0.002). In a multivariable linear regression analysis, CAC score was inversely related to CFR in both diabetic patients (p < 0.05) and nondiabetic patients (p < 0.001). CONCLUSION Diabetic patients had higher CAC scores than nondiabetic patients, but the difference disappeared when clinical characteristics were taken into account. Of note, diabetic patients also had lower CFR regardless of CAC score than nondiabetic patients after matching. Thus, coronary atherosclerotic burden and vascular function have to be seen as two different entities.
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Affiliation(s)
- Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.,Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Parthiban Arumugam
- Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Valeria Gaudieri
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Mariarosaria Panico
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Mario Magliulo
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Christine M Tonge
- Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
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28
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Abstract
Noninvasive assessment of coronary artery disease remains a challenging task, with a large armamentarium of diagnostic modalities. Myocardial perfusion imaging (MPI) is widely used for this purpose whereby cardiac positron emission tomography (PET) is considered the gold standard. Next to relative radiotracer distribution, PET allows for measurement of absolute myocardial blood flow. This quantification of perfusion improves diagnostic accuracy and prognostic value. Cardiac hybrid imaging relies on the fusion of anatomical and functional imaging using coronary computed tomography angiography and MPI, respectively, and provides incremental value as compared with either stand-alone modality.
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29
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Goto Y, Kitagawa K, Uno M, Nakamori S, Ito T, Nagasawa N, Dohi K, Sakuma H. Diagnostic Accuracy of Endocardial-to-Epicardial Myocardial Blood Flow Ratio for the Detection of Significant Coronary Artery Disease With Dynamic Myocardial Perfusion Dual-Source Computed Tomography. Circ J 2017; 81:1477-1483. [DOI: 10.1253/circj.cj-16-1319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Mio Uno
- Department of Radiology, Mie University Hospital
| | | | - Tatsuro Ito
- Department of Radiology, Mie University Hospital
| | | | - Kaoru Dohi
- Department of Cardiology, Mie University Hospital
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30
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Comparison of rubidium-82 myocardial blood flow quantification with coronary calcium score for evaluation of coronary artery stenosis. Nucl Med Commun 2016; 37:197-206. [PMID: 26485453 DOI: 10.1097/mnm.0000000000000410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION PET myocardial perfusion imaging (MPI) is the standard technique for assessing myocardial function, but provides limited information on the anatomy of cardiac structures whereas the coronary artery calcium (CAC) score provides information on calcified plaque burden and the anatomical structure of the coronary arteries. The aim of this study was to determine the relationship between quantitative myocardial blood flow (MBF), CAC, and coronary artery disease (CAD). This work also aims to determine whether MBF quantification and/or CAC add value to relative MPI, and aid in the reclassification of patients with CAD. This way, a 'gatekeeper' study could be identified to predict coronary artery stenosis and improve our clinical service. MATERIALS AND METHODS Rubidium-82 PET/CT MPI, calcium score, and computed tomographic coronary angiography imaging were performed in 128 patients with known or suspected CAD. The presence of ischemia was assessed from qualitative reporting of rubidium-82 MPI, and using the same data, quantitative values of MBF and coronary flow reserve (CFR) were derived. Calcium score images were quantitatively analyzed and categorized into three groups defined by CAC values of 0, 1-400, and >400. Significant stenosis was classified as stenosis of 50% or more on computed tomographic angiography. RESULTS A total of 120 patients were included in the final analysis (77 men, 43 women). Our results showed an inverse correlation between stress MBF, CFR, and the percentage stenosis as well as an inverse correlation compared with CAC. A direct correlation between CAC and the percentage stenosis was observed, indicating that an increase in coronary calcification in individual coronary arteries is related to the severity of the coronary stenosis. These results proved that the addition of stress MBF to relative MPI (32%) resulted in a significantly higher sensitivity (48%, P=0.002), which increased significantly more with the addition of CFR (58%, P≤0.001). The further addition of CAC resulted in a significantly higher sensitivity (80%, P=0.001), with an even higher sensitivity with the addition of both CFR and CAC (95%, P≤0.001) to relative MPI. CONCLUSION The addition of quantitative MBF conferred a substantial added diagnostic value to relative MPI for the diagnosis of CAD by highlighting compromised flow with the addition of CAC, increasing this added value even more. We recommend that this approach should be used to predict the presence of coronary artery stenosis at its earliest stage and guide physicians when making decisions on the management pathway of CAD without exposing patients to a high radiation dose during cardiac angiography.
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Papanastasiou G, Williams MC, Dweck MR, Alam S, Cooper A, Mirsadraee S, Newby DE, Semple SI. Quantitative assessment of myocardial blood flow in coronary artery disease by cardiovascular magnetic resonance: comparison of Fermi and distributed parameter modeling against invasive methods. J Cardiovasc Magn Reson 2016; 18:57. [PMID: 27624746 PMCID: PMC5022209 DOI: 10.1186/s12968-016-0270-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/29/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Mathematical modeling of perfusion cardiovascular magnetic resonance (CMR) data allows absolute quantification of myocardial blood flow and can potentially improve the diagnosis and prognostication of obstructive coronary artery disease (CAD), against the current clinical standard of visual assessments. This study compares the diagnostic performance of distributed parameter modeling (DP) against the standard Fermi model, for the detection of obstructive CAD, in per vessel against per patient analysis. METHODS A pilot cohort of 28 subjects (24 included in the final analysis) with known or suspected CAD underwent adenosine stress-rest perfusion CMR at 3T. Data were analysed using Fermi and DP modeling against invasive coronary angiography and fractional flow reserve, acquired in all subjects. Obstructive CAD was defined as luminal stenosis of ≥70 % alone, or luminal stenosis ≥50 % and fractional flow reserve ≤0.80. RESULTS On ROC analysis, DP modeling outperformed the standard Fermi model, in per vessel and per patient analysis. In per patient analysis, DP modeling-derived myocardial blood flow at stress demonstrated the highest sensitivity and specificity (0.96, 0.92) in detecting obstructive CAD, against Fermi modeling (0.78, 0.88) and visual assessments (0.79, 0.88), respectively. CONCLUSIONS DP modeling demonstrated consistently increased diagnostic performance against Fermi modeling and showed that it may have merit for stratifying patients with at least one vessel with obstructive CAD. TRIAL REGISTRATION CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01368237 Registered 6 of June 2011. URL: https://clinicaltrials.gov/ct2/show/NCT01368237.
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Affiliation(s)
- Giorgos Papanastasiou
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Marc R. Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Shirjel Alam
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Annette Cooper
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Saeed Mirsadraee
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - David E. Newby
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Scott I. Semple
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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Clinical Utility and Future Applications of PET/CT and PET/CMR in Cardiology. Diagnostics (Basel) 2016; 6:diagnostics6030032. [PMID: 27598207 PMCID: PMC5039566 DOI: 10.3390/diagnostics6030032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022] Open
Abstract
Over the past several years, there have been major advances in cardiovascular positron emission tomography (PET) in combination with either computed tomography (CT) or, more recently, cardiovascular magnetic resonance (CMR). These multi-modality approaches have significant potential to leverage the strengths of each modality to improve the characterization of a variety of cardiovascular diseases and to predict clinical outcomes. This review will discuss current developments and potential future uses of PET/CT and PET/CMR for cardiovascular applications, which promise to add significant incremental benefits to the data provided by each modality alone.
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Lee JM, Kim CH, Koo BK, Hwang D, Park J, Zhang J, Tong Y, Jeon KH, Bang JI, Suh M, Paeng JC, Cheon GJ, Na SH, Ahn JM, Park SJ, Kim HS. Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by
13
N-ammonia Positron Emission Tomography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004768. [DOI: 10.1161/circimaging.116.004768] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/21/2016] [Indexed: 12/25/2022]
Abstract
Background—
Recent evidence suggests that the diagnostic accuracy of myocardial perfusion imaging is improved by quantifying stress myocardial blood flow (MBF) in absolute terms. We evaluated a comprehensive quantitative
13
N-ammonia positron emission tomography (
13
NH
3
-PET) diagnostic panel, including stress MBF, coronary flow reserve (CFR), and relative flow reserve (RFR) in conjunction with relative perfusion defect (PD) assessments to better detect functionally significant coronary artery stenosis.
Methods and Results—
A total of 130 patients (307 vessels) with coronary artery disease underwent both
13
NH
3
-PET and invasive coronary angiography with fractional flow reserve (FFR) measurement. Diagnostic accuracy, optimal cut points, and discrimination indices of respective
13
NH
3
-PET quantitative measures were compared, with FFR as standard reference. The capacity to discern disease with stepwise addition of stress MBF, CFR, and RFR to qualitatively assessed relative PD was also gauged, using the category-free net reclassification index. All quantitative measures showed significant correlation with FFR (PET-derived CFR,
r
=0.388; stress MBF,
r
=0.496; and RFR,
r
=0.780; all
P
<0.001). Optimal respective cut points for FFR ≤0.8 and ≤0.75 were 1.99 and 1.84 mL/min per g for stress MBF and 2.12 and 2.00 for PET-derived CFR. Discrimination indices of quantitative measures that correlated with FFR ≤0.8 were all significantly higher than that of relative PD (area under the curve: 0.626, 0.730, 0.806, and 0.897 for relative PD, CFR, stress MBF, and RFR, respectively; overall comparison
P
<0.001). The capacity for functionally significant coronary stenosis was incrementally improved by the successive addition of CFR (net reclassification index=0.629), stress MBF (net reclassification index=0.950), and RFR (net reclassification index=1.253; all
P
<0.001) to relative PD.
Conclusions—
Integrating quantitative
13
NH
3
-PET measures with qualitative myocardial perfusion assessment provides superior diagnostic accuracy and improves the capacity to detect functionally significant coronary artery stenosis.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT01621438 and NCT01366404.
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Affiliation(s)
- Joo Myung Lee
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Chee Hae Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Bon-Kwon Koo
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Doyeon Hwang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jonghanne Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jinlong Zhang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Yaliang Tong
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ki-Hyun Jeon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ji-In Bang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Minseok Suh
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jin Chul Paeng
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Gi Jeong Cheon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Sang-Hoon Na
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jung-Min Ahn
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Seung-Jung Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Hyo-Soo Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
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Stuijfzand WJ, Raijmakers PG, Driessen RS, Lammertsma AA, van Rossum AC, Nap A, Appelman Y, Lemkes JS, van Leeuwen MA, van Royen N, Knaapen P. Evaluation of myocardial blood flow and coronary flow reserve after implantation of a bioresorbable vascular scaffold versus metal drug-eluting stent: an interim one-month analysis of the VANISH trial. EUROINTERVENTION 2016; 12:e584-94. [DOI: 10.4244/eijv12i5a98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Range FT, Kies P, Schäfers KP, Breithardt G, Schober O, Wichter T, Schäfers MA. Sex differences in absolute myocardial perfusion. Non-invasive H2(15)O-PET in young healthy adults. Nuklearmedizin 2016; 55:196-202. [PMID: 27437761 DOI: 10.3413/nukmed-0821-16-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/17/2016] [Indexed: 11/20/2022]
Abstract
AIM To investigate sex differences in myocardial perfusion especially in healthy individuals since former studies are rare and findings are controversial. Participants, methods: 26 subjects were enrolled: 16 healthy women (age: 34 ±7 years) were compared with 10 healthy men (age: 34 ± 3 years; p = ns). Myocardial blood flow (MBF) and coronary vascular resistance (CVR) were quantified at rest, during adenosine infusion and cold-pressor-testing, using positron emission tomography and radioactive-labelled water (H2(15)O-PET). RESULTS Women showed higher MBF than men at rest (1.10 ± 0.18 vs. 0.85 ± 0.20 ml/min/ml; p = 0.003) and cold-stress (1.39 ± 0.38 vs. 1.06 ± 0.28 ml/min/ml; p = 0.026). Corrected for rate-pressure-product, baseline findings maintained significance (1.41 ± 0.33 vs. 1.16 ± 0.19 ml/min/ml; p = 0.024). CVR was lower in women at baseline (81 ± 14 vs. 107 ± 22 mmHg*ml(-1)*min*ml; p = 0.006) and during cold-pressor-testing (71 ± 17 vs. 91 ± 20 mmHg*ml(-1)*min*ml; p = 0.013). Under adenosine neither maximal MBF (4.06 ± 1.0 vs. 3.91 ± 0.88 ml/min/ml; p = ns) nor coronary flow reserve (3.07 ± 1.12 vs. 3.44 ± 0.92; p = ns) nor CVR (24 ± 8 vs. 24 ± 6 mmHg*ml(-1)*min*ml; p = ns) showed sex-related differences. CONCLUSION Women show higher myocardial perfusion and lower coronary vascular resistance than men in physiologic states. Maximum perfusion and vasodilation under adenosine are not sex-specific.
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Affiliation(s)
- Felix T Range
- Dr. med. Felix Range, Universitätsklinikum Düsseldorf, Klinik für Kardiologie, Pneumologie und Angiologie, Moorenstr. 5, 40225 Düsseldorf, Germany, Tel. +49/(0)211/811-88 00, Fax -95 20,
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Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A. Prevalence of Coronary Microvascular Dysfunction Among Patients With Chest Pain and Nonobstructive Coronary Artery Disease. JACC Cardiovasc Interv 2016; 8:1445-1453. [PMID: 26404197 DOI: 10.1016/j.jcin.2015.06.017] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/11/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study assessed the prevalence of coronary microvascular abnormalities in patients presenting with chest pain and nonobstructive coronary artery disease (CAD). BACKGROUND Coronary microvascular abnormalities mediate ischemia and can lead to an increased risk of cardiovascular events. METHODS Using an intracoronary Doppler guidewire, endothelial-dependent microvascular function was examined by evaluating changes in coronary blood flow in response to acetylcholine, whereas endothelial-independent microvascular function was examined by evaluating changes in coronary flow velocity reserve in response to intracoronary adenosine. Patients were divided into 4 groups depending on whether they had a normal (+) or abnormal (-) coronary blood flow (CBF) in response to acetylcholine (Ach) and a normal (+) or abnormal (-) coronary flow velocity reserve (CFR) in response to adenosine (Adn): CBFAch+, CFRAdn+ (n = 520); CBFAch-, CFRAdn+ (n = 478); CBFAch+, CFRAdn- (n = 173); and CBFAch-, CFRAdn- (n = 268). RESULTS Two-thirds of all patients had some sort of microvascular dysfunction. Women were more prevalent in each group (56% to 82%). Diabetes was uncommon in all groups (7% to 12%), whereas hypertension and hyperlipidemia were relatively more prevalent in each group, although rates for most conventional cardiovascular risk factors did not differ significantly between groups. There were no significant differences in the findings of noninvasive functional testing between groups. In a multivariable analysis, age was the only variable that independently predicted abnormal microvascular function. CONCLUSIONS Patients with chest pain and nonobstructive CAD have a high prevalence of coronary microvascular abnormalities. These abnormalities correlate poorly with conventional cardiovascular risk factors and are dissociated from the findings of noninvasive functional testing.
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Affiliation(s)
- Jaskanwal D Sara
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota
| | - R Jay Widmer
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota
| | - Yasushi Matsuzawa
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, Minnesota
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota.
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Vliegenthart R, De Cecco CN, Wichmann JL, Meinel FG, Pelgrim GJ, Tesche C, Ebersberger U, Pugliese F, Bamberg F, Choe YH, Wang Y, Schoepf UJ. Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension: Insights from a multicenter registry. J Cardiovasc Comput Tomogr 2016; 10:301-8. [DOI: 10.1016/j.jcct.2016.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/17/2016] [Accepted: 05/22/2016] [Indexed: 11/27/2022]
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Danad I, Szymonifka J, Schulman-Marcus J, Min JK. Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging 2016; 17:836-44. [PMID: 27013250 DOI: 10.1093/ehjci/jew044] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/18/2016] [Indexed: 12/13/2022] Open
Abstract
Recent developments in computed tomography (CT) technology have fulfilled the prerequisites for the clinical application of myocardial CT perfusion (CTP) imaging. The evaluation of myocardial perfusion by CT can be achieved by static or dynamic scan acquisitions. Although both approaches have proved clinically feasible, substantial barriers need to be overcome before its routine clinical application. The current review provides an outline of the current status of CTP imaging and also focuses on disparities between static and dynamic CTPs for the evaluation of myocardial blood flow.
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Affiliation(s)
- Ibrahim Danad
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
| | - Jackie Szymonifka
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
| | | | - James K Min
- NewYork-Presbyterian Hospital and Weill Cornell Medicine, 413 E. 69th Street, Suite 108, New York 10021, NY, USA Dalio Institute of Cardiovascular Imaging, New York, NY, USA
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Teunissen PFA, de Waard GA, Hollander MR, Robbers LFHJ, Danad I, Biesbroek PS, Amier RP, Echavarría-Pinto M, Quirós A, Broyd C, Heymans MW, Nijveldt R, Lammertsma AA, Raijmakers PG, Allaart CP, Lemkes JS, Appelman YE, Marques KM, Bronzwaer JGF, Horrevoets AJG, van Rossum AC, Escaned J, Beek AM, Knaapen P, van Royen N. Doppler-derived intracoronary physiology indices predict the occurrence of microvascular injury and microvascular perfusion deficits after angiographically successful primary percutaneous coronary intervention. Circ Cardiovasc Interv 2015; 8:e001786. [PMID: 25717044 DOI: 10.1161/circinterventions.114.001786] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A total of 40% to 50% of patients with ST-segment-elevation myocardial infarction develop microvascular injury (MVI) despite angiographically successful primary percutaneous coronary intervention (PCI). We investigated whether hyperemic microvascular resistance (HMR) immediately after angiographically successful PCI predicts MVI at cardiovascular magnetic resonance and reduced myocardial blood flow at positron emission tomography (PET). METHODS AND RESULTS Sixty patients with ST-segment-elevation myocardial infarction were included in this prospective study. Immediately after successful PCI, intracoronary pressure-flow measurements were performed and analyzed off-line to calculate HMR and indices derived from the pressure-velocity loops, including pressure at zero flow. Cardiovascular magnetic resonance and H2 (15)O PET imaging were performed 4 to 6 days after PCI. Using cardiovascular magnetic resonance, MVI was defined as a subendocardial recess of myocardium with low signal intensity within a gadolinium-enhanced area. Myocardial perfusion was quantified using H2 (15)O PET. Reference HMR values were obtained in 16 stable patients undergoing coronary angiography. Complete data sets were available in 48 patients of which 24 developed MVI. Adequate pressure-velocity loops were obtained in 29 patients. HMR in the culprit artery in patients with MVI was significantly higher than in patients without MVI (MVI, 3.33±1.50 mm Hg/cm per second versus no MVI, 2.41±1.26 mm Hg/cm per second; P=0.03). MVI was associated with higher pressure at zero flow (45.68±13.16 versus 32.01±14.98 mm Hg; P=0.015). Multivariable analysis showed HMR to independently predict MVI (P=0.04). The optimal cutoff value for HMR was 2.5 mm Hg/cm per second. High HMR was associated with decreased myocardial blood flow on PET (myocardial perfusion reserve <2.0, 3.18±1.42 mm Hg/cm per second versus myocardial perfusion reserve ≥2.0, 2.24±1.19 mm Hg/cm per second; P=0.04). CONCLUSIONS Doppler-flow-derived physiological indices of coronary resistance (HMR) and extravascular compression (pressure at zero flow) obtained immediately after successful primary PCI predict MVI and decreased PET myocardial blood flow. CLINICAL TRIAL REGISTRATION URL http://www.trialregister.nl. Unique identifier: NTR3164.
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Affiliation(s)
- Paul F A Teunissen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Guus A de Waard
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Maurits R Hollander
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Lourens F H J Robbers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Ibrahim Danad
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - P Stefan Biesbroek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Raquel P Amier
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Mauro Echavarría-Pinto
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Alicia Quirós
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Christopher Broyd
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Martijn W Heymans
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Robin Nijveldt
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Adriaan A Lammertsma
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Pieter G Raijmakers
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Cornelis P Allaart
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jorrit S Lemkes
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Yolande E Appelman
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Koen M Marques
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Jean G F Bronzwaer
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Anton J G Horrevoets
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Albert C van Rossum
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Javier Escaned
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Aernout M Beek
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Paul Knaapen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.)
| | - Niels van Royen
- From the Departments of Cardiology (P.F.A.T., G.A.d.W., M.R.H., L.F.H.J.R., I.D., P.S.B., R.P.A., R.N., C.P.A., J.S.L., Y.E.A., K.M.M., J.G.F.B., A.C.v.R., A.M.B., P.K., N.v.R.), Epidemiology and Biostatistics (M.W.H.), Radiology and Nuclear Medicine (A.A.L., P.G.R.), and Molecular Cell Biology and Immunology (A.J.G.H.), VU University Medical Center, Amsterdam, The Netherlands; and Cardiovascular Institute, Hospital Clinico San Carlos/Complutense University, Madrid, Spain (M.E.-P., A.Q., C.B., J.E.).
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Teunissen PFA, Timmer SAJ, Danad I, de Waard GA, van de Ven PM, Raijmakers PG, Lammertsma AA, Van Rossum AC, van Royen N, Knaapen P. Coronary vasomotor function in infarcted and remote myocardium after primary percutaneous coronary intervention. Heart 2015; 101:1577-83. [DOI: 10.1136/heartjnl-2015-307825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/09/2015] [Indexed: 11/04/2022] Open
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Absolute Versus Relative Myocardial Blood Flow by Dynamic CT Myocardial Perfusion Imaging in Patients With Anatomic Coronary Artery Disease. AJR Am J Roentgenol 2015; 205:W67-72. [DOI: 10.2214/ajr.14.14087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bakkum MJ, Danad I, Romijn MAJ, Stuijfzand WJA, Leonora RM, Tulevski II, Somsen GA, Lammertsma AA, van Kuijk C, van Rossum AC, Raijmakers PG, Knaapen P. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function. Eur J Nucl Med Mol Imaging 2015; 42:1562-73. [PMID: 26054890 PMCID: PMC4521095 DOI: 10.1007/s00259-015-3087-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
Purpose Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. Methods A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [15O]H2O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Results Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg×ml−1×min−1×g−1, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. Conclusion EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. Electronic supplementary material The online version of this article (doi:10.1007/s00259-015-3087-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M. J. Bakkum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. Danad
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - M. A. J. Romijn
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - W. J. A. Stuijfzand
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - R. M. Leonora
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I. I. Tulevski
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - G. A. Somsen
- />Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - A. A. Lammertsma
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - C. van Kuijk
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - A. C. van Rossum
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - P. G. Raijmakers
- />Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - P. Knaapen
- />Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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Rijnierse MT, Allaart CP, de Haan S, Harms HJ, Huisman MC, Wu L, Beek AM, Lammertsma AA, van Rossum AC, Knaapen P. Sympathetic denervation is associated with microvascular dysfunction in non-infarcted myocardium in patients with cardiomyopathy. Eur Heart J Cardiovasc Imaging 2015; 16:788-98. [PMID: 25711350 DOI: 10.1093/ehjci/jev013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/19/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Sympathetic denervation typically occurs in the infarcted myocardium and is associated with sudden cardiac death. Impaired innervation was also demonstrated in non-infarcted myocardium in ischaemic and dilated cardiomyopathy (ICMP and DCMP). Factors affecting sympathetic nerve integrity in remote myocardium are unknown. Perfusion abnormalities, even in the absence of epicardial coronary artery disease, may relate to sympathetic dysfunction. This study was aimed to assess the interrelations of myocardial blood flow (MBF), contractile function, and sympathetic innervation in non-infarcted remote myocardium. METHODS AND RESULTS Seventy patients with ICMP or DCMP and LVEF ≤35% were included. [(15)O]H2O- and [(11)C]hydroxyephedrine (HED) PET was performed to quantify resting MBF, hyperaemic MBF, and sympathetic innervation. Cardiovascular magnetic resonance (CMR) imaging was performed to assess left ventricular function, mass, wall thickening, and scar size. Wall thickening, [(11)C]HED retention index (RI), and MBF were assessed in remote segments without scar, selected on CMR. [(11)C]HED RI was correlated with resting MBF (r = 0.41, P < 0.001) and hyperaemic MBF (r = 0.55, P < 0.001) in remote myocardium in both ICMP and DCMP. In addition, LV volumes (r = -0.40, P = 0.001), LV mass (r = -0.31, P = 0.008), and wall thickening (r = 0.45, P < 0.001) correlated with remote [(11)C]HED RI. Multivariable analysis revealed that hyperaemic MBF (B = 0.79, P < 0.001), wall thickening (B = 0.01, P = 0.03), and LVEDV (B = -0.03, P = 0.02) were independent predictors for remote [(11)C]HED RI. CONCLUSION Hyperaemic MBF is independently associated with sympathetic innervation in non-infarcted remote myocardium in patients with ICMP and DCMP. This suggests that microvascular dysfunction might be an important factor related to sympathetic nerve integrity. Whether impaired hyperaemic MBF is the primary cause of this relation remains unclear.
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Affiliation(s)
- Mischa T Rijnierse
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Stefan de Haan
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Hendrik J Harms
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc C Huisman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - LiNa Wu
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Aernout M Beek
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, PO Box 7057, Amsterdam, HV 1081, The Netherlands Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
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Relative Myocardial Blood Flow by Dynamic Computed Tomographic Perfusion Imaging Predicts Hemodynamic Significance of Coronary Stenosis Better Than Absolute Blood Flow. Invest Radiol 2014; 49:801-7. [DOI: 10.1097/rli.0000000000000087] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Camici PG, d'Amati G, Rimoldi O. Coronary microvascular dysfunction: mechanisms and functional assessment. Nat Rev Cardiol 2014; 12:48-62. [DOI: 10.1038/nrcardio.2014.160] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Quantitative Assessment of Myocardial Perfusion in the Detection of Significant Coronary Artery Disease. J Am Coll Cardiol 2014; 64:1464-75. [DOI: 10.1016/j.jacc.2014.05.069] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/02/2014] [Accepted: 05/13/2014] [Indexed: 02/06/2023]
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Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, Dorbala S, Blankstein R, Rimoldi O, Camici PG, Di Carli MF. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 2014; 129:2518-27. [PMID: 24787469 DOI: 10.1161/circulationaha.113.008507] [Citation(s) in RCA: 414] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is a prevalent and prognostically important finding in patients with symptoms suggestive of coronary artery disease. The relative extent to which CMD affects both sexes is largely unknown. METHODS AND RESULTS We investigated 405 men and 813 women who were referred for evaluation of suspected coronary artery disease with no previous history of coronary artery disease and no visual evidence of coronary artery disease on rest/stress positron emission tomography myocardial perfusion imaging. Coronary flow reserve was quantified, and coronary flow reserve <2.0 was used to define the presence of CMD. Major adverse cardiac events, including cardiac death, nonfatal myocardial infarction, late revascularization, and hospitalization for heart failure, were assessed in a blinded fashion over a median follow-up of 1.3 years (interquartile range, 0.5-2.3 years). CMD was highly prevalent both in men and women (51% and 54%, respectively; Fisher exact test =0.39; equivalence P=0.0002). Regardless of sex, coronary flow reserve was a powerful incremental predictor of major adverse cardiac events (hazard ratio, 0.80 [95% confidence interval, 0.75-086] per 10% increase in coronary flow reserve; P<0.0001) and resulted in favorable net reclassification improvement (0.280 [95% confidence interval, 0.049-0.512]), after adjustment for clinical risk and ventricular function. In a subgroup (n=404; 307 women/97 men) without evidence of coronary artery calcification on gated computed tomography imaging, CMD was common in both sexes, despite normal stress perfusion imaging and no coronary artery calcification (44% of men versus 48% of women; Fisher exact test P=0.56; equivalence P=0.041). CONCLUSIONS CMD is highly prevalent among at-risk individuals and is associated with adverse outcomes regardless of sex. The high prevalence of CMD in both sexes suggests that it may be a useful target for future therapeutic interventions.
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Affiliation(s)
- Venkatesh L Murthy
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Masanao Naya
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Viviany R Taqueti
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Courtney R Foster
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Mariya Gaber
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Jon Hainer
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Sharmila Dorbala
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Ron Blankstein
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Ornella Rimoldi
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Paolo G Camici
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.)
| | - Marcelo F Di Carli
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, and Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI (V.L.M.); Noninvasive Cardiovascular Imaging Program, Departments of Internal Medicine and Radiology (V.L.M., M.N., V.R.T., S.D., R.B., M.F.D.C.), and Division of Cardiovascular Medicine, Department of Medicine (V.L.M., V.R.T., J.H., S.D., R.B., M.F.D.C.), Brigham & Women's Hospital, Boston, MA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (C.R.F., M.G., J.H., S.D., M.F.D.C.), and Istituto di Bioimmagini e Fisiologia Molecolare (O.R.), Consiglio Nazionale delle Ricerche and Scientific Institute San Raffaele, Milan, Italy; Division of Cardiology, Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.).
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Danad I, Raijmakers PG, Harms HJ, Heymans MW, van Royen N, Lubberink M, Boellaard R, van Rossum AC, Lammertsma AA, Knaapen P. Impact of anatomical and functional severity of coronary atherosclerotic plaques on the transmural perfusion gradient: a [15O]H2O PET study. Eur Heart J 2014; 35:2094-105. [PMID: 24780500 DOI: 10.1093/eurheartj/ehu170] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Myocardial ischaemia occurs principally in the subendocardial layer, whereas conventional myocardial perfusion imaging provides no information on the transmural myocardial blood flow (MBF) distribution. Subendocardial perfusion measurements and quantification of the transmural perfusion gradient (TPG) could be more sensitive and specific for the detection of coronary artery disease (CAD). The current study aimed to determine the impact of lesion severity as assessed by the fractional flow reserve (FFR) on subendocardial perfusion and the TPG using [(15)O]H2O positron emission tomography (PET) imaging in patients evaluated for CAD. METHODS AND RESULTS Sixty-six patients with anginal chest pain were prospectively enrolled and underwent [(15)O]H2O myocardial perfusion PET imaging. Subsequently, invasive coronary angiography was performed and FFR obtained in all coronary arteries irrespective of the PET imaging results. Thirty (45%) patients were diagnosed with significant CAD (i.e. FFR ≤0.80), whereas on a per vessel analysis (n = 198), 53 (27%) displayed a positive FFR. Transmural hyperaemic MBF decreased significantly from 3.09 ± 1.16 to 1.67 ± 0.57 mL min(-1) g(-1) (P < 0.001) in non-ischaemic and ischaemic myocardium, respectively. The TPG decreased during hyperaemia when compared with baseline (1.20 ± 0.14 vs. 0.94 ± 0.17, P < 0.001), and was lower in arteries with a positive FFR (0.97 ± 0.16 vs. 0.88 ± 0.18, P < 0.01). A TPG threshold of 0.94 yielded an accuracy to detect CAD of 59%, which was inferior to transmural MBF with an optimal cutoff of 2.20 mL min(-1) g(-1) and an accuracy of 85% (P < 0.001). Diagnostic accuracy of subendocardial perfusion measurements was comparable with transmural MBF (83 vs. 85%, respectively, P = NS). CONCLUSION Cardiac [(15)O]H2O PET imaging is able to distinguish subendocardial from subepicardial perfusion in the myocardium of normal dimensions. Hyperaemic TPG is significantly lower in ischaemic myocardium. This technique can potentially be employed to study subendocardial perfusion impairment in more detail. However, the diagnostic accuracy of subendocardial hyperaemic perfusion and TPG appears to be limited compared with quantitative transmural MBF, warranting further study.
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Affiliation(s)
- Ibrahim Danad
- Department of Cardiology, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV, The Netherlands
| | - Pieter G Raijmakers
- Department of Nuclear Medicine & PET Research and Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hendrik J Harms
- Department of Nuclear Medicine & PET Research and Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV, The Netherlands
| | - Mark Lubberink
- Uppsala University PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Ronald Boellaard
- Department of Nuclear Medicine & PET Research and Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV, The Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine & PET Research and Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV, The Netherlands
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49
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Rijnierse MT, de Haan S, Harms HJ, Robbers LF, Wu L, Danad I, Beek AM, Heymans MW, van Rossum AC, Lammertsma AA, Allaart CP, Knaapen P. Impaired Hyperemic Myocardial Blood Flow Is Associated With Inducibility of Ventricular Arrhythmia in Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:20-30. [DOI: 10.1161/circimaging.113.001158] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background—
Risk stratification for ventricular arrhythmias (VAs) is important to refine selection criteria for primary prevention implantable cardioverter defibrillator therapy. Impaired hyperemic myocardial blood flow (MBF) is associated with increased mortality rate in ischemic and nonischemic cardiomyopathy, which may be attributed to electric instability inducing VAs. The aim of this pilot study was to assess whether hyperemic MBF impairment may be related with VA inducibility in patients with ischemic cardiomyopathy.
Methods and Results—
Thirty patients with ischemic cardiomyopathy referred for primary prevention implantable cardioverter defibrillator implantation were prospectively included (26 men; 65±8 years old; left ventricular ejection fraction, 29±6%). [
15
O]H
2
O positron-emission tomography was performed to quantify resting MBF, hyperemic MBF, and coronary flow reserve. Left ventricular dimensions, function, and scar burden were assessed with cardiovascular magnetic resonance imaging. An electrophysiological study was performed to test VA inducibility. Positive electrophysiological study patients (n=12) showed reduced hyperemic MBF (1.25±0.30 versus 1.66±0.38 mL·min
−1
·g
−1
;
P
<0.01) and coronary flow reserve (1.59±0.49 versus 2.12±0.48;
P
<0.01) compared with electrophysiological study negative patients (n=18). In electrophysiological study positive patients, the number of scar segments >75% transmurality was higher (
P
<0.05), although scar size and border zone did not differ. Receiver-operating characteristic curve analysis indicated that impaired hyperemic MBF (area under the curve, 0.84; 95% confidence intervals [0.69–0.99]) and coronary flow reserve (area under the curve, 0.77; 95% confidence intervals [0.57–0.96]) were associated with VA inducibility.
Conclusions—
In this pilot study, impaired hyperemic MBF and coronary flow reserve were associated with VA inducibility in patients with ischemic cardiomyopathy. These results are hypothesis generating for a potential role of quantitative positron-emission tomography perfusion imaging in risk stratification for VAs.
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Affiliation(s)
- Mischa T. Rijnierse
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Stefan de Haan
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Hendrik J. Harms
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Lourens F. Robbers
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - LiNa Wu
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Ibrahim Danad
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Aernout M. Beek
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W. Heymans
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C. van Rossum
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A. Lammertsma
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Knaapen
- From the Department of Cardiology and Institute for Cardiovascular Research (M.T.R., S.d.H., L.F.R., L.N.W., I.D., A.M.B., A.C.v.R., C.P.A., P.K.), Departments of Radiology and Nuclear Medicine (H.J.H., A.A.L.), Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, The Netherlands
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Effect of type 2 diabetes mellitus on epicardial adipose tissue volume and coronary vasomotor function. Am J Cardiol 2014; 113:90-7. [PMID: 24169015 DOI: 10.1016/j.amjcard.2013.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 12/27/2022]
Abstract
Patients with coronary artery disease and/or type 2 diabetes mellitus (DM) generally exhibit more epicardial adipose tissue (EAT) than healthy controls. Recently, it has been proposed that EAT affects vascular function and structure by secreting proinflammatory and vasoactive substances, thereby potentially contributing to the development of cardiovascular disease. In the present study, the interrelation of EAT, coronary vasomotor function, and coronary artery calcium was investigated in patients with and without DM, who were evaluated for coronary artery disease. Myocardial blood flow (MBF) was assessed at rest and during adenosine-induced hyperemia using [(15)O]-water positron emission tomography combined with computed tomography to quantify coronary artery calcium and EAT in 199 patients (46 with DM). In this cohort (mean age 58 ± 10 years), the patients with DM had a greater body mass index, heart rate, and systolic blood pressure at rest (all p <0.05). Coronary artery calcium and the EAT volumes were comparable between those with and without DM. Both patient groups showed comparable MBF at rest and coronary vascular resistance. A lower hyperemic MBF and coronary flow reserve (CFR) and greater hyperemic coronary vascular resistance (all p <0.05) was observed in the patients with DM. A pooled analysis showed a positive association of EAT volume with hyperemic coronary vascular resistance but not with the MBF at rest, hyperemic MBF, or coronary vascular resistance at rest. In the group analysis, the EAT volume was inversely associated with hyperemic MBF (r = -0.16, p = 0.05) and CFR (r = -0.17, p = 0.04) and positively with hyperemic coronary vascular resistance (r = 0.26, p = 0.002) only in patients without DM. Multivariate regression analysis, adjusted for age, gender, and body mass index, showed an independent association between the EAT volume and hyperemic MBF (β = -0.16, p = 0.02), CFR (β = -0.16, p = 0.04), and hyperemic coronary vascular resistance (β = 0.25, p <0.001) in the non-DM group. In conclusion, these results suggest a role for EAT in myocardial microvascular dysfunction; however, once DM has developed, other factors might be more dominant in contributing to impaired myocardial microvascular dysfunction.
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