1
|
Apostolopoulos DJ, Kaspiri A, Spyridonidis T, Patsouras N, Savvopoulos CA, Davlouros P, Vassilakos PJ, Alexopoulos D. Assessment of absolute Tc-99m tetrofosmin retention in the myocardium as an index of myocardial blood flow and coronary flow reserve by gated-SPECT/CT: a feasibility study. Ann Nucl Med 2015; 29:588-602. [DOI: 10.1007/s12149-015-0982-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 12/24/2022]
|
2
|
Ohira H, Dowsley T, Dwivedi G, deKemp RA, Chow BJ, Ruddy TD, Davies RA, DaSilva J, Beanlands RSB, Hessian R. Quantification of myocardial blood flow using PET to improve the management of patients with stable ischemic coronary artery disease. Future Cardiol 2014; 10:611-31. [DOI: 10.2217/fca.14.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Cardiac PET has been evolving over the past 30 years. Today, it is accepted as a valuable imaging modality for the noninvasive assessment of coronary artery disease. PET has demonstrated superior diagnostic accuracy for the detection of coronary artery disease compared with single-photon emission computed tomography, and also has a well-established prognostic value. The routine addition of absolute quantification of myocardial blood flow increases the diagnostic accuracy for three-vessel disease and provides incremental functional and prognostic information. Moreover, the characterization of the vasodilator capacity of the coronary circulation may guide proper decision-making and monitor the effects of lifestyle changes, exercise training, risk factor modification or medical therapy for improving regional and global myocardial blood flow. This type of image-guided approach to individualized patient therapy is now attainable with the routine use of cardiac PET flow reserve imaging.
Collapse
Affiliation(s)
- Hiroshi Ohira
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Taylor Dowsley
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Girish Dwivedi
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Robert A deKemp
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin J Chow
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Terrence D Ruddy
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ross A Davies
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jean DaSilva
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob SB Beanlands
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Renee Hessian
- MFI program, National Cardiac PET Center, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
3
|
Daniele S, Nappi C, Acampa W, Storto G, Pellegrino T, Ricci F, Xhoxhi E, Porcaro F, Petretta M, Cuocolo A. Incremental prognostic value of coronary flow reserve assessed with single-photon emission computed tomography. J Nucl Cardiol 2011; 18:612-9. [PMID: 21626091 DOI: 10.1007/s12350-011-9345-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/24/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND We assessed the prognostic value of coronary flow reserve (CFR) estimated by single-photon emission computed tomography (SPECT) in patients with suspected myocardial ischemia. METHODS AND RESULTS Myocardial perfusion and CFR were assessed in 106 patients using dipyridamole/rest Tc-99m sestamibi SPECT and follow-up was obtained in 103 (97%) patients. Four early revascularized patients were excluded and 99 were assigned to normal (summed stress score <3) vs abnormal myocardial perfusion and to normal (≥2.0) vs abnormal CFR. During the follow-up (5.8 ± 2.1 years), 28 patients experienced a cardiac event (cardiac death, nonfatal myocardial infarction, and late revascularization). Abnormal perfusion (P < .01) and abnormal CFR (P < .05) were independent predictors of cardiac events at Cox proportional hazard regression analysis. Also in patients with normal perfusion, abnormal CFR was associated with a higher annual event rate compared with normal CFR (5.2% vs 0.7%; P < .05). CFR data improved the prognostic power of the model including clinical and myocardial perfusion data increasing the global chi-square from 18.6 to 22.8 (P < .05). Finally, at parametric survival analysis, in patients with normal perfusion the time to achieve ≥2% risk of events was >60 months in those with normal and <12 months in those with abnormal CFR. CONCLUSIONS Myocardial perfusion findings and CFR at SPECT imaging are both independent predictors of cardiac events. Estimated CFR provides incremental prognostic information over those obtained from clinical and myocardial perfusion data, particularly in patients with normal perfusion findings.
Collapse
Affiliation(s)
- Stefania Daniele
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Naples, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Storto G, Soricelli A, Pellegrino T, Petretta M, Cuocolo A. Assessment of the arterial input function for estimation of coronary flow reserve by single photon emission computed tomography: comparison of two different approaches. Eur J Nucl Med Mol Imaging 2011; 36:2034-41. [PMID: 19526233 DOI: 10.1007/s00259-009-1186-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Attempts to estimate coronary flow reserve (CFR) with single photon emission computed tomography (SPECT) tracers have been recently made. We compared two different methods for the estimation of CFR by SPECT imaging. METHODS Fourteen patients with coronary artery disease underwent dipyridamole 99mTc-sestamibi SPECT and intracoronary Doppler within 5 days. Myocardial blood flow (MBF) was estimated by measurement of first transit counts in the right pulmonary artery (PA) and left ventricular (LV) chamber, and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress MBF to rest MBF. RESULTS Rest and stress MBF obtained using first transit counts from PA were higher compared to that from LV chamber (rest: 1.05 ± 0.38 vs 0.87 ± 0.34 counts/pixel per s, respectively, p < 0.01 and stress: 1.34 ± 0.45 vs 0.91 ± 0.20 counts/pixel per s, respectively, p < 0.05). In the study vessels, CFR by Doppler was 1.39 ± 0.42, and SPECT CFR obtained using first transit counts from PA and LV chamber were 1.36 ± 0.43 and 1.16 ± 0.39, respectively (p across categories NS). A significant relationship between SPECT CFR obtained using first transit counts from PA and CFR by Doppler was found (r = 0.85, p < 0.001). No relationship between SPECT CFR obtained using first transit counts from LV chamber and CFR by intracoronary Doppler was OBSERVED (R = 0.43, P = NS). CONCLUSION SPECT-estimated CFR obtained using first transit counts from right PA is more accurate and correlates better with the results of intracoronary Doppler than estimated CFR obtained using arterial input function from LV chamber.
Collapse
|
6
|
Petretta M, Soricelli A, Storto G, Cuocolo A. Assessment of coronary flow reserve using single photon emission computed tomography with technetium 99m-labeled tracers. J Nucl Cardiol 2008; 15:456-65. [PMID: 18513652 DOI: 10.1016/j.nuclcard.2008.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The quantitative assessment of coronary flow reserve (CFR) may be useful for the functional evaluation of coronary artery disease (CAD), allowing judgment of its severity, tracking of disease progression, and evaluation of the anti-ischemic efficacy of therapeutic strategies. Invasive techniques, such as intracoronary Doppler ultrasound and the pressure-derived method, which directly assess CFR velocity and fractional flow reserve, have been used for the evaluation of the physiologic significance of coronary lesions. Considerable progress has been made in the improvement of technologies directed toward the noninvasive quantification of myocardial blood flow and CFR. Positron emission tomography has emerged as an accurate technique to quantify CFR. The absolute measurements obtained with this noninvasive approach have been widely validated. Nevertheless, it has not been applied to routine studies because of its high cost and complexity. On the other hand, technetium 99m-labeled tracers have been largely used for the evaluation of myocardial perfusion with single photon emission computed tomography (SPECT) imaging in patients with suspected or known CAD. Recently, attempts to estimate CFR with SPECT tracers have been made to obtain, with noninvasive methods, data for quantitative functional assessment of CAD. This review analyzes the relative merit and limitations of CFR measurements by cardiac SPECT imaging with Tc-99m-labeled tracers and describes the potential clinical applications of this technique.
Collapse
Affiliation(s)
- Mario Petretta
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
| | | | | | | |
Collapse
|