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Gyllenhammar T, Carlsson M, Jögi J, Arheden H, Engblom H. Myocardial perfusion by CMR coronary sinus flow shows sex differences and lowered perfusion at stress in patients with suspected microvascular angina. Clin Physiol Funct Imaging 2022; 42:208-219. [PMID: 35279944 PMCID: PMC9310583 DOI: 10.1111/cpf.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Tom Gyllenhammar
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Marcus Carlsson
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Jonas Jögi
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Håkan Arheden
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
| | - Henrik Engblom
- Department of Clinical Physiology Lund University, and Skåne University Hospital Sweden
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Byrne C, Kjaer A, Olsen NE, Forman JL, Hasbak P. Test-retest repeatability and software reproducibility of myocardial flow measurements using rest/adenosine stress Rubidium-82 PET/CT with and without motion correction in healthy young volunteers. J Nucl Cardiol 2021; 28:2860-2871. [PMID: 32390111 DOI: 10.1007/s12350-020-02140-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Myocardial flow reserve (MFR) assessment with cardiac positron emission computed tomography (PET/CT) is well established, and quantification relies on commercial software packages. However, for reliable use, repeatability and reproducibility are important. The aim of this study was therefore to investigate and compare between scans and software packages the repeatability and reproducibility of 82Rb-PET/CT estimated MFR. METHODS AND RESULTS Forty healthy volunteers completed two 82Rb-PET/CT rest and adenosine stress scans. syngo.MBF (Siemens), quantitative-gated SPECT (QGS) (Cedars-Sinai), and Corridor4DM (4DM) were used for analyses. Motion correction was available for 4DM. Fifty percent were men and age was 24 ± 4 years (mean ± SD). Repeatability of MFR varied between scans. syngo.MBF: mean difference (95% CI) 0.26 (- 0.03 to 0.54), P = 0.07, limits of agreement (LoA): - 1.43 to 1.95; QGS: 0.19 (- 0.08 to 0.46), P = 0.15, LoA: - 1.38 to 1.76; 4DM: 0.08 (- 0.17 to 0.34), P = 0.50, LoA: - 1.37 to 1.53; and 4DM motion corrected: 0.17 (- 0.17 to 0.51), P = 0.32, LoA: - 1.89 to 2.22. MFR was higher using 4DM +/- motion correction compared with syngo.MBF and QGS (all P < 0.0001). Concordance between syngo.MBF and QGS was high (P = 0.83). CONCLUSIONS Reproducibility of MFR varied for the different software. The highest concordance between MFRs was found between syngo.MBF and QGS.
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, 9841, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja Enevold Olsen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Copenhagen University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Achieving Low Radiation Dose in "One-Stop" Myocardial Computed Tomography Perfusion Imaging in Coronary Artery Disease Using 16-cm Wide Detector CT. Acad Radiol 2020; 27:1531-1539. [PMID: 31859211 DOI: 10.1016/j.acra.2019.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of "one-stop" myocardial computed tomography perfusion (CTP) imaging (combined anatomy, perfusion, and function) in coronary artery disease using 16-cm wide detector CT, compared to conventional coronary CT angiography (CCTA). MATERIALS AND METHODS 442 patients with suspected coronary artery disease were randomly divided into two groups. Patients in group A underwent "one-stop" CTP, whereas group B underwent conventional CCTA. Image quality of CT images was assessed. Radiation and contrast medium doses and scan time of the two groups were recorded. Group A was further divided into four subgroups according to the degree of coronary artery stenosis, for which transmural perfusion ratio (TPR) and left ventricular ejection fraction (LVEF) were measured. RESULTS Scan time was 73.1 ± 7.3 (s) longer in group A than in group B with 11.7% reduction of radiation dose (p < 0.001) and no significant difference in image quality was noted. Significant differences regarding the minimum TPR (F = 24.657, p < 0.001) and LVEF (χ2 =36.98, p < 0.001) were observed among four subgroups. A negative correlation was found between the degree of coronary artery stenosis and TPR of the corresponding myocardial segments (r = -0.55, p < 0.001). Patients with moderate to severe arterial stenosis exhibited a decreased LVEF compared to those with normal coronary arteries (48.0% vs 56.5%, p < 0.001). CONCLUSION Compared to conventional CCTA, our new developed "one-stop" CTP may provide more comprehensive information on myocardial perfusion, coronary artery stenosis, and LV cardiac function with reduced radiation and contrast medium doses.
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Forte E, Punzo B, Gentile F, Salvatore M, Cavaliere C, Cademartiri F. Normal patterns of left ventricle rest myocardial perfusion assessed by third-generation cardiac computed tomography. Clin Physiol Funct Imaging 2019; 40:30-36. [PMID: 31578827 DOI: 10.1111/cpf.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate diastolic and systolic patterns of segmental and transmural rest perfusion of the left ventricle (LV) in normal subjects (NS) undergoing third-generation dual-source cardiac computed tomography (CCT). METHODS Forty consecutive NS, with normal coronary arteries and cardiac chambers both anatomically and functionally on the basis of CCT, were retrospectively enrolled in the study. Relative normalized myocardial attenuation density (rnMAD) and transmural perfusion ratio (TPR) were calculated in diastole and systole for each segment and layer of the LV and then pooled into territories. RESULTS Statistical analysis showed that sub-endocardial rnMAD was significantly higher than intra-myocardial and sub-epicardial for all myocardial territories both in systolic and diastolic phases (P<0·001). Basal and mid-ventricular rnMAD were higher than apical for all myocardial layers (P<0·001). Septum displayed higher rnMAD in intra-myocardium and sub-epicardium (179 ± 61 and 170 ± 59 in diastole and 172 ± 60 and 166 ± 58 in systole, respectively) than the anterior, lateral and inferior wall (P<0·001). Diastolic and systolic TPR were significantly different for the anterior and lateral wall (P<0·001), while septal TPR (1·06 ± 0·06 in diastole and 1·05 ± 0·06 in systole, respectively) was the lowest as compared to other territories' TPR. Finally, basal, mid-ventricular and apical TPR showed a significant linear trend with basal lower than mid-ventricular and apical values. CONCLUSION Inter-territory and inter-layer myocardial perfusion differences can be accurately assessed with CCT in NS. This assessment is the basic step to further evaluate abnormal rest perfusion patterns in ischaemic and non-ischaemic diseases.
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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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Bechsgaard DF, Gustafsson I, Linde JJ, Kofoed KF, Prescott E, Hove JD. Myocardial perfusion assessed with cardiac computed tomography in women without coronary heart disease. Clin Physiol Funct Imaging 2018; 39:65-77. [DOI: 10.1111/cpf.12542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/27/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Daria Frestad Bechsgaard
- Department of Cardiology; Hvidovre University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Ida Gustafsson
- Department of Cardiology; Hvidovre University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Jesper James Linde
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Eva Prescott
- Department of Cardiology; Bispebjerg University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology; Hvidovre University Hospital; University of Copenhagen; Copenhagen Denmark
- Center for Functional and Diagnostic Imaging; Hvidovre University Hospital; University of Copenhagen; Hvidovre Denmark
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Cai X, Zhang S, Deng D, Li H, Guan X, Fang J, Zhou Q. Myocardial perfusion at rest in uncomplicated type 2 diabetes patients without coronary artery disease evaluated by 320-multidetector computed tomography: A pilot study. Medicine (Baltimore) 2018; 97:e9762. [PMID: 29384863 PMCID: PMC5805435 DOI: 10.1097/md.0000000000009762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Using computed tomography myocardial perfusion imaging (CTP) to investigate resting myocardial perfusion alterations in uncomplicated type 2 diabetes mellitus (T2DM) patients without obstructive coronary artery disease (CAD).A total of 34 participants with 544 myocardial segments were included prospectively: 17 uncomplicated T2DM patients with no significant coronary artery stenosis on coronary computed tomography angiography and 17 healthy controls. Myocardial perfusion was evaluated by transmural perfusion ratio (TPR). Parameters of cardiac structure and function were measured for cardiac comprehensive assessment. Analyses included descriptive statistics and group comparisons.TPR of segments 5, 7, 9, 10 to 14 were significantly reduced in T2DM group compared with controls (P < .05). When 16 myocardial segments were localized into different areas according to the wall orientations, axial levels of left ventricle and coronary artery territories, respectively, TPR of each area in T2DM group were significantly lower than those in the control group (P < .05). No significant differences were found in cardiac anatomy and function analyses between 2 groups.In uncomplicated T2DM patients without obstructive CAD, myocardial perfusion impairments were present and may develop prior to cardiac morphological and functional abnormalities, which can be early detected by CTP.
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Affiliation(s)
- Xiangyi Cai
- Medical Imaging Center, First Affiliated Hospital of Jinan University
| | - Shuihua Zhang
- Medical Imaging Center, First Affiliated Hospital of Jinan University
| | - Dabiao Deng
- Department of Radiology, Guangdong 999 Brain Hospital, Guangzhou, Guangdong, China
| | - Honglin Li
- Medical Imaging Center, First Affiliated Hospital of Jinan University
| | - Xueqing Guan
- Medical Imaging Center, First Affiliated Hospital of Jinan University
| | - Jin Fang
- Medical Imaging Center, First Affiliated Hospital of Jinan University
| | - Quan Zhou
- Medical Imaging Center, First Affiliated Hospital of Jinan University
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Kofoed KF, Sørgaard MH, Linde JJ. Functional Information in Coronary Artery Disease: The Case of Computed Tomography Myocardial Perfusion. Curr Cardiol Rep 2017; 19:126. [PMID: 29071430 DOI: 10.1007/s11886-017-0937-8] [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] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW To review methodological and logistical aspects of CT myocardial perfusion, current clinical evidence and possible future directions, with specific focus on use in patients with coronary artery disease (CAD). RECENT FINDINGS CT myocardial perfusion imaging may be performed as an add-on to standard coronary CT angiography (CCTA), to identify regions of myocardial hypoperfusion, at rest and during adenosine stress. The principle of measurement is well-validated in animal experimental models, and CT myocardial perfusion imaging has a high degree of concordance with already clinically available perfusion imaging methods. Combining CCTA and CT myocardial perfusion imaging increases the diagnostic accuracy to identify patients with CAD associated with ischemia. In patients suspected of CAD, CCTA frequently detects coronary atherosclerotic lesions, in which revascularization could be clinically beneficial. CT myocardial perfusion imaging may be helpful to identify coronary lesions associated with myocardial ischemia, and thus potentially suitable for coronary intervention.
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Affiliation(s)
- Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
- Department of Cardiology 2014, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Radiology, The Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Mathias H Sørgaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper J Linde
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Park J, Kim HS, Hwang HJ, Yang DH, Koo HJ, Kang JW, Kim YH. Geographic and demographic variabilities of quantitative parameters in stress myocardial computed tomography perfusion. Korean J Intern Med 2017; 32:847-854. [PMID: 28750502 PMCID: PMC5583451 DOI: 10.3904/kjim.2016.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the geographic and demographic variabilities of the quantitative parameters of computed tomography perfusion (CTP) of the left ventricular (LV) myocardium in patients with normal coronary artery on computed tomography angiography (CTA). METHODS From a multicenter CTP registry of stress and static computed tomography, we retrospectively recruited 113 patients (mean age, 60 years; 57 men) without perfusion defect on visual assessment and minimal (< 20% of diameter stenosis) or no coronary artery disease on CTA. Using semiautomatic analysis software, quantitative parameters of the LV myocardium, including the myocardial attenuation in stress and rest phases, transmural perfusion ratio (TPR), and myocardial perfusion reserve index (MPRI), were evaluated in 16 myocardial segments. RESULTS In the lateral wall of the LV myocardium, all quantitative parameters except for MPRI were significantly higher compared with those in the other walls. The MPRI showed consistent values in all myocardial walls (anterior to lateral wall: range, 25% to 27%; p = 0.401). At the basal level of the myocardium, all quantitative parameters were significantly lower than those at the mid- and apical levels. Compared with men, women had significantly higher values of myocardial attenuation and TPR. Age, body mass index, and Framingham risk score were significantly associated with the difference in myocardial attenuation. CONCLUSIONS Geographic and demographic variabilities of quantitative parameters in stress myocardial CTP exist in healthy subjects without significant coronary artery disease. This information may be helpful when assessing myocardial perfusion defects in CTP.
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Affiliation(s)
- Jinoh Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Sook Kim
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Hyun-Sook Kim, M.D. Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-3979 Fax: +82-31-386-2269 E-mail:
| | - Hye Jeon Hwang
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Hyun Yang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kühl JT, George RT, Mehra VC, Linde JJ, Chen M, Arai AE, Di Carli M, Kitagawa K, Dewey M, Lima JAC, Kofoed KF. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease: insights from the CORE320 multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:779-87. [PMID: 26341292 DOI: 10.1093/ehjci/jev206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/02/2015] [Indexed: 12/15/2022] Open
Abstract
AIM Previous animal studies have demonstrated differences in perfusion and perfusion reserve between the subendocardium and subepicardium. 320-row computed tomography (CT) with sub-millimetre spatial resolution allows for the assessment of transmural differences in myocardial perfusion reserve (MPR) in humans. We aimed to test the hypothesis that MPR in all myocardial layers is determined by age, gender, and cardiovascular risk profile in patients with ischaemic symptoms or equivalent but without obstructive coronary artery disease (CAD). METHODS AND RESULTS A total of 149 patients enrolled in the CORE320 study with symptoms or signs of myocardial ischaemia and absence of significant CAD by invasive coronary angiography were scanned with static rest and stress CT perfusion. Myocardial attenuation densities were assessed at rest and during adenosine stress, segmented into 3 myocardial layers and 13 segments. MPR was higher in the subepicardium compared with the subendocardium (124% interquartile range [45, 235] vs. 68% [22,102], P < 0.001). Moreover, MPR in the septum was lower than in the inferolateral and anterolateral segments of the myocardium (55% [19, 104] vs. 89% [37, 168] and 124% [54, 270], P < 0.001). By multivariate analysis, high body mass index was significantly associated with reduced MPR in all myocardial layers when adjusted for cardiovascular risk factors (P = 0.02). CONCLUSION In symptomatic patients without significant coronary artery stenosis, distinct differences in endocardial-epicardial distribution of perfusion reserve may be demonstrated with static CT perfusion. Low MPR in all myocardial layers was observed specifically in obese patients.
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Affiliation(s)
- Jørgen Tobias Kühl
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Richard T George
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vishal C Mehra
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jesper J Linde
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marcus Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew E Arai
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Marc Dewey
- Charitè Medical School, Humboldt, Berlin, Germany
| | - Joao A C Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 2012, The Heart Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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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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Byrne C, Jensen T, Hjortkjær HØ, Mogensen UM, Kuhl JT, Fuchs A, Hilsted J, Nordestgaard BG, Køber L, Kofoed KF. Myocardial perfusion at rest in patients with Diabetes Mellitus Type 1 compared with healthy controls assessed with Multi Detector Computed Tomography. Diabetes Res Clin Pract 2015; 107:15-22. [PMID: 25467625 DOI: 10.1016/j.diabres.2014.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/18/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
AIM Type 1 diabetes mellitus (T1DM) is associated with an increased risk of ischemic heart disease (IHD). The relative contribution of structural and functional abnormalities of the coronary circulation determining clinically manifested IHD remains unknown. The aim of this study was to assess potential differences in myocardial perfusion at rest and coronary atherosclerosis between asymptomatic T1DM patients and healthy controls. METHODS Left ventricular (LV) myocardial perfusion at rest measured as LV myocardial Attenuation Density/LV blood pool Attenuation Density (MyoAD-ratio) and coronary artery atherosclerosis were evaluated with 320-multidetector computed tomography angiography in 57 asymptomatic T1DM patients and 114 sex and age matched controls. RESULTS In both groups median age was 53 years (p5,p95: 42,67) and 59.6% were men. Median duration of diabetes in the T1DM group was 35 years (p5,p95: 17,49). Median coronary calcium score was higher in T1DM patients (51 vs. 2, p=0.037) compared with controls. However, a similar frequency of >50% stenosis in one or more coronary arteries was found in T1DM patients and controls (18% vs. 14%, p=0.49). LV myocardial perfusion at rest (MyoAD-ratio) was 18% higher in T1DM patients than controls (0.13 vs. 0.11, p<0.0001). This difference was noted throughout all the LV myocardial segments. In a multiple regression analysis including diabetes, sex, age, cardiovascular risk factors, heart rate, calcium score and coronary stenosis >50%, MyoAD-ratio remained significantly higher in T1DM patients (p=0.0001). CONCLUSIONS LV myocardial perfusion at rest is higher in T1DM patients compared with controls independent of coronary atherosclerosis and cardiovascular risk factors.
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
| | - Tonny Jensen
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | | | - U M Mogensen
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - J T Kuhl
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Jannik Hilsted
- Department of Endocrinology, Rigshospitalet, University of Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev Hospital, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark
| | - K F Kofoed
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University of Copenhagen, Denmark
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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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