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Kitkungvan D, Johnson NP, Roby AE, Mendoza P, Bui L, Patel MB, Sander K, Harmon L, Kirkeeide R, Gould KL. Quantitative myocardial perfusion in liver transplantation candidates: Poorly metabolized caffeine inhibition of vasodilatory stress. J Nucl Cardiol 2024; 38:101884. [PMID: 38761831 DOI: 10.1016/j.nuclcard.2024.101884] [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: 01/17/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Data on cardiac positron emission tomography (PET) in liver transplantation (LT) candidates are limited with no prior study accounting for poorly metabolized caffeine reducing stress perfusion. METHOD Consecutive LT candidates (n = 114) undergoing cardiac rest/stress PET were instructed to abstain from caffeine for 2 days extended to 5 and 7 days. Due to persistently high prevalence of measurable blood caffeine after 5-day caffeine abstinence, dipyridamole (n = 41) initially used was changed to dobutamine (n = 73). Associations of absolute flow, coronary flow reserve (CFR), detectable blood caffeine, and Modified End-Stage Liver Disease (MELD) score for liver failure severity were evaluated. Coronary flow data of LT candidates were compared to non-LT control group (n = 102 for dipyridamole, n = 29 for dobutamine). RESULTS Prevalence of patients with detectable blood caffeine was 63.3%, 36.7% and 33.3% after 2-, 5- and 7-day of caffeine abstinence, respectively. MELD score was associated with detectable caffeine (odd ratio 1.18,P < 0.001). CFR was higher during dipyridamole stress without-caffeine versus with-caffeine (2.22 ± 0.80 vs 1.55 ± 0.37,P = 0.048) but lower than dobutamine stress (2.22 ± 0.80 vs 2.82 ± 1.02,P = 0.026). Mediation analysis suggested that the dominant association between CFR and MELD score in dipyridamole group derived from caffeine-impaired CFR and liver failure/caffeine interaction. CFR in LT candidates was lower than non-LT control population in both dipyridamole and dobutamine group. CONCLUSION We demonstrate exceptionally high prevalence of detectable blood caffeine in LT candidates undergoing stress PET myocardial perfusion imaging resulting in reduced CFR with dipyridamole compared to dobutamine. The delayed caffeine clearance in LT candidates makes dobutamine a preferred stress agent in this population.
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Affiliation(s)
- Danai Kitkungvan
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Nils P Johnson
- Weatherhead Distinguished Chair of Heart Disease, Division of Cardiology, McGovern Medical School, University of Texas, Houston, USA
| | - Amanda E Roby
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Patricia Mendoza
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Linh Bui
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Monica B Patel
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Kelly Sander
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Lindsey Harmon
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - Richard Kirkeeide
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, USA
| | - K Lance Gould
- Martin Bucksbaum Distinguished University Chair, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas, Houston, USA.
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Lim P, Agarwal V, Patel KK. How to assess nonresponsiveness to vasodilator stress. J Nucl Cardiol 2024; 36:101850. [PMID: 38518887 PMCID: PMC11180564 DOI: 10.1016/j.nuclcard.2024.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
Myocardial perfusion imaging (MPI) is a powerful tool for the functional assessment of ischemia in patients with suspected or known coronary artery disease (CAD). Given that the diagnostic accuracy and prognostic value of MPI and post-test management are highly dependent on achieving an adequate stress vasodilatory response, it is critical to identify those who may not have adequately responded to vasodilator pharmacological stress agents such as adenosine, dipyridamole, and regadenoson. Caffeine, a potent inhibitor of the adenosine receptor, is a compound that can affect vasodilatory hemodynamics, result in false negative studies, and potentially alter management in cases of inaccurate test results. Vasodilator non-responsiveness can be suspected by examining hemodynamics, quantitative positron emission tomography (PET) metrics such as myocardial flow reserve (MFR), and splenic response to stress. Quantitative MFR values of 1-1.2 should raise suspicion for nonresponsiveness in the setting of normal perfusion, along with the absence of a splenic switch off. Newer metrics, such as splenic response ratio, can be used to aid in the identification of potential nonresponders to pharmacologic vasodilators.
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Affiliation(s)
- Phillip Lim
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Vikram Agarwal
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Krishna K Patel
- Department of Medicine (Cardiology), Mount Sinai Morningside Hospital, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
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Kitkungvan D, Johnson NP, Bui L, Patel MB, Roby AE, Haynie M, Kirkeeide R, Hood S, Gould KL. Does financial hardship associate with abnormal quantitative myocardial perfusion and major adverse cardiovascular event? J Nucl Cardiol 2023; 30:1528-1539. [PMID: 36639611 DOI: 10.1007/s12350-022-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Data on impact of financial hardship on coronary artery disease (CAD) remain incomplete. METHODS Consecutive subjects referred for clinical rest/stress cardiac positron emission tomography (PET) were enrolled. Financial hardship is defined as patients' inability to pay for their out-of-pocket expense for cardiac PET. Abnormal cardiac PET is defined as at least moderate relative perfusion defects at stress involving > 10% of the left ventricle or global coronary flow reserve ≤ 2.0. Patients were followed for major adverse cardiovascular event (MACE) comprised of all-cause mortality, non-fatal myocardial infarction, and late coronary revascularization. RESULTS We analyzed a total of 4173 patients with mean age 65.6 ± 11.3 years, 72.2% men, and 93.6% reported as having medical insurance. Of these, 504 (12.1%) patients had financial hardship. On multivariable analysis, financial hardship associated with abnormal cardiac PET (odds ratio 1.377, p = 0.004) and MACE (hazard ratio 1.432, p = 0.010) and its association with MACE was mostly through direct effect with small proportion mediated by abnormal cardiac PET or known CAD. CONCLUSION Among patients referred for cardiac rest/stress PET, financial hardship independently associates with myocardial perfusion abnormalities and MACE; however, its effect on MACE is largely not mediated by abnormal myocardial perfusion or known CAD suggesting distinct impact of financial hardship beyond traditional risk factors and CAD that deserves attention and intervention to effectively reduced adverse outcomes. Having medical insurance does not consistently protect from financial hardship and a more preventive-oriented restructuring may provide better outcomes at lower cost.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nils P Johnson
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Monica B Patel
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda E Roby
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mary Haynie
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Richard Kirkeeide
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Hood
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Lance Gould
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Lassen ML, Wissenberg M, Byrne C, Sheykhzade M, Hurry PK, Schmedes AV, Kjær A, Hasbak P. Image-derived and physiological markers to predict adequate adenosine-induced hyperemic response in Rubidium-82 myocardial perfusion imaging. J Nucl Cardiol 2022; 29:3207-3217. [PMID: 35149976 PMCID: PMC9834126 DOI: 10.1007/s12350-022-02906-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023]
Abstract
AIMS This study aimed to investigate the potential of different markers to identify adequate stressing in subjects with and without caffeine intake prior to Rubidium-82 myocardial imaging. METHODS AND RESULTS This study comprised 40 healthy subjects who underwent four serial Rubidium-82 rest/adenosine stress MPI; two with 0mg caffeine consumption (baseline MPIs) and two with controlled consumption of caffeine (arm 1: 100 and 300mg, or arm 2: 200 and 400mg). We report the sensitivity and specificity of seven markers ability to predict adequate adenosine-induced hyperemic response: (1) the splenic response ratio (SRR); (2) splenic stress-to-rest intensity ratios (SIR); (3) changes in heart rate (ΔHR); (4) percentwise change in heart rate (Δ%HR); (5) changes in the rate pressure product (ΔRPP); (6) changes in the systolic blood pressure (ΔSBP); and (7) changes in the cardiovascular resistance (ΔCVR). Adequate stressing was determined as stress myocardial blood flow > 3ml/g/min and a corresponding myocardial flow reserve >68% of the individual maximum myocardial flow reserve obtained in the baseline MPIs. RESULTS 129 MPI sessions (obtained in 39 subjects) were considered for this study. The following sensitivities were obtained: SSR = 72.7%, SIR = 63.6%, ΔHR = 45.5%, Δ%HR = 77.3%, ΔRPP = 54.5%, ΔSBP = 47.7%, and ΔCVR =40.9%, while the specificities were SSR = 80.9%, SIR = 85.0%, ΔHR = 90.4%, Δ%HR = 81.6%, ΔRPP=81.1%, ΔSBP = 86.4%, and ΔCVR =90.4%. CONCLUSION The image-derived and physiological markers all provide acceptable sensitivities and specificities when patients follow the caffeine pausation before MPI. However, their use warrants great care when caffeine consumption cannot be ruled out.
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Affiliation(s)
- Martin Lyngby Lassen
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mads Wissenberg
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Christina Byrne
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preetee Kapisha Hurry
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Philip Hasbak
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, of Biomedical Sciences, Section 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Liu FS, Wang SY, Shiau YC, Wu YW. Integration of quantitative absolute myocardial blood flow estimates from dynamic CZT-SPECT improves the detection of coronary artery disease. J Nucl Cardiol 2022; 29:2311-2321. [PMID: 34240342 DOI: 10.1007/s12350-021-02713-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Balanced ischemia with multi-vessel coronary artery disease (CAD) is difficult to diagnose with semiquantitative single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Dynamic cardiac SPECT provides quantitative estimations of stenosis severity and ischemic burden by assessing myocardial flow reserve (MFR) and myocardial blood flow (MBF). The aim of this study was to evaluate the incremental value of dynamic SPECT in multi-vessel coronary artery disease (CAD). METHODS Patients with suspected CAD who underwent dynamic ECG-gated dipyridamole MPI and coronary angiography within 6 months were retrospectively reviewed. The performance of summed stress, rest and difference scores (SSS, SRS, SDS), post-stress and resting MBF (MBFs, MBFr) and MFR were compared at both patient level and vessel level. RESULTS In 32 patients with 39 stenotic vessels, 12 had three-vessel disease (38%). Globally increased SSS and impaired MBF values were significantly associated with significant CAD at the patient level, but SDS and MFR were not. Regional increases in SSS and reductions in both MBFs and MBFr were significantly associated with stenotic vessels. The best cutoff value of global MBFs to predict CAD was 3.5 ml·g-1·min-1 (area under the curve, AUC = .84, P = .002). The best cutoff value of regional MBFs to detect significant stenosis was 3.6 ml·g-1·min-1 (AUC = .74, P < .001). However, the best possible cut-off values of MFR were not found. Sex-difference in both global and regional MBFr but MBFs was found, which might result in the non-significance in MFR. CONCLUSIONS This study validated a clinically available method to quantify MFR using dynamic CZT-SPECT. This method improved the detectability of multi-vessel CAD, and absolute MBFs was superior to MFR and other semiquantitative MPI parameters.
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Affiliation(s)
- Fang-Shin Liu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi County, Taiwan
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Yu-Chien Shiau
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- National Yang-Ming University School of Medicine, Taipei City, Taiwan.
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
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Matsumoto H, Masaki R, Higuchi S, Tanaka H, Kondo S, Tsujita H, Shinke T. Impact of overestimation of fractional flow reserve by adenosine on anatomical-functional mismatch. Sci Rep 2022; 12:14962. [PMID: 36056128 PMCID: PMC9440099 DOI: 10.1038/s41598-022-19330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical-functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/PaADN) and papaverine (Pd/PaPAP) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/PaADN-Pd/PaPAP. The anatomical-functional mismatch was defined as diameter stenosis > 50% and Pd/PaADN > 0.80. Reclassification was indicated by Pd/PaADN > 0.80 and Pd/PaPAP ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01-0.05) versus 0.01 (0.00-0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical-functional mismatch. Anatomical-functional mismatch, specifically in the LAD, may suggest a false-negative result.
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Affiliation(s)
- Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Ryota Masaki
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Satoshi Higuchi
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hideaki Tanaka
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Seita Kondo
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Nappi C, Ponsiglione A, Falzarano M, Imbriaco M, Klain M, Cuocolo A. Insights into Myocardial Perfusion PET Imaging: the Coronary Flow Capacity. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose of Review
The present work summarizes the clinical relevance of coronary flow capacity (CFC) with an eye on future perspectives.
Recent findings
CFC concept has been recently introduced providing a comprehensive framework for coronary physiology evaluation.
Summary
It has been widely demonstrated that coronary artery disease (CAD) is a complex disease with a multifactorial etiology resulting from different pathogenic mechanisms. Cardiac positron emission tomography (PET) currently represents the gold standard for CAD assessment, providing absolute myocardial perfusion data including coronary flow reserve (CFR), calculated as the ratio of hyperemic to rest absolute myocardial blood flows. CFC can be obtained from dynamic PET images by plotting the primary stress perfusion data and CFR values for each pixel on a graph of predefined exact ranges. The routine evaluation of this parameter may add diagnostic and prognostic value to clinical and conventional imaging data.
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Kero T, Saraste A, Lagerqvist B, Sörensen J, Pikkarainen E, Lubberink M, Knuuti J. Quantitative myocardial perfusion response to adenosine and regadenoson in patients with suspected coronary artery disease. J Nucl Cardiol 2022; 29:24-36. [PMID: 34386859 PMCID: PMC8873130 DOI: 10.1007/s12350-021-02731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND The aim of the present study was to compare the quantitative flow responses of regadenoson against adenosine using cardiac 15O-water PET imaging in patients with suspected or known coronary artery disease (CAD). METHODS Hyperemic myocardial blood flow (MBF) after adenosine and regadenoson was compared using correlation and Bland-Altman analysis in 21 patients who underwent rest and adenosine 15O-water PET scans followed by rest and regadenoson 15O-water PET scans. RESULTS Global mean (± SD) MBF values at rest and stress were 0.92 ± 0.27 and 2.68 ± 0.80 mL·g·min for the adenosine study and 0.95 ± 0.29 and 2.76 ± 0.79 mL·g·min for the regadenoson study (P = 0.55 and P = 0.49). The correlations between global and regional adenosine- and regadenoson-based stress MBF were strong (r = 0.80 and r = 0.77). The biases were small for both global and regional MBF comparisons (0.08 and 0.09 mL·min·g), but the limits of agreement were wide for stress MBF. CONCLUSION The correlation between regadenoson- and adenosine-induced hyperemic MBF was strong but the agreement was only moderate indicating that established cut-off values for 150-water PET should be used cautiously if using regadenoson as vasodilator.
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Affiliation(s)
- Tanja Kero
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden.
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - Antti Saraste
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Bo Lagerqvist
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Essi Pikkarainen
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Juhani Knuuti
- Turku PET Centre, Turku, Finland
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
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Tanaka H, Matsumoto H, Takahashi H, Hosonuma M, Sato S, Ogura K, Oishi Y, Masaki R, Sakai K, Sekimoto T, Kondo S, Tsujita H, Tsukamoto S, Sumida A, Okada N, Inoue K, Shinke T. Linear concentration-response relationship of serum caffeine with adenosine-induced fractional flow reserve overestimation: a comparison with papaverine. EUROINTERVENTION 2021; 17:e925-e931. [PMID: 34647891 PMCID: PMC9725067 DOI: 10.4244/eij-d-21-00453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Caffeine intake from one cup of coffee one hour before adenosine stress tests, corresponding to serum caffeine levels of 3-4 mg/L, is thought to be acceptable for non-invasive imaging. AIMS We aimed to elucidate whether serum caffeine is independently associated with adenosine-induced fractional flow reserve (FFR) overestimation and their concentration-response relationship. METHODS FFR was measured using adenosine (FFRADN) and papaverine (FFRPAP) in 209 patients. FFRADN overestimation was defined as FFRADN - FFRPAP. The locally weighted scatterplot smoothing (LOWESS) approach was applied to evaluate the relationship between serum caffeine level and FFRADN overestimation. Multiple regression analysis was used to determine independent factors associated with FFRADN overestimation. RESULTS Caffeine was ingested at <12 hours in 85 patients, at 12-24 hours in 35 patients, and at >24 hours in 89 patients. Multiple regression analysis identified serum caffeine level as the strongest factor associated with FFRADN overestimation (p<0.001). The LOWESS curve demonstrated that FFRADN overestimation started from just above the lower detection limit of serum caffeine and increased approximately 0.01 FFR unit per 1 mg/L increase in serum caffeine level with a linear relationship. The 90th percentile of serum caffeine levels for the ≤12-hour, the 12-24-hour, and the >24-hour groups corresponded to FFRADN overestimations by 0.06, 0.03, and 0.02, respectively. CONCLUSIONS Serum caffeine overestimates FFRADN values in a linear concentration-response manner. FFRADN overestimation occurs at much lower serum caffeine levels than those that were previously believed. Our results highlight that standardised caffeine control is required for reliable adenosine-induced FFR measurements.
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Affiliation(s)
- Hideaki Tanaka
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Haruya Takahashi
- Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Uji, Kyoto, Japan
| | - Masahiro Hosonuma
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Shunya Sato
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Kunihiro Ogura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryota Masaki
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Koshiro Sakai
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shigeto Tsukamoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Arihiro Sumida
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Natsumi Okada
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Kazuo Inoue
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
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Lassen ML, Byrne C, Sheykhzade M, Wissenberg M, Hurry PK, Schmedes AV, Kjaer A, Hasbak P. Gender differences and caffeine impact in adenosine-induced hyperemia. J Nucl Med 2021; 63:431-437. [PMID: 34244355 PMCID: PMC8978189 DOI: 10.2967/jnumed.121.261970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Caffeine consumption before adenosine stress myocardial perfusion imaging (MPI) is known to affect the hemodynamic response and, thus, reduce the stress myocardial blood flow (MBF) and myocardial flow reserve (MFR) assessments. However, it is not clear if any gender-specific differences in the hemodynamic response following caffeine consumption exist. This study aimed to evaluate if such differences exist and, if so, their impact on MBF and MFR assessments. Methods: This study comprised 40 healthy volunteers (19 women). All volunteers underwent four serial rest/stress MPI sessions employing Rubidium-82; two sessions were acquired without controlled caffeine consumption, and two sessions following oral ingestion of either 100mg and 300mg caffeine or 200mg and 400mg caffeine. For the caffeine imaging sessions, caffeine was ingested orally 1hr before the MPI scan. Results: Increase in plasma caffeine concentration (PCC) (mg/l) following consumption of caffeine was larger in women (MPI session without caffeine vs. MPI session with caffeine: women = 0.3±0.2 vs. 5.4±5.1, men = 0.1±0.2 vs. 2.7±2.6, both p<0.001). Caffeine consumption led to reduced stress MBF and MFR assessments for men while no changes were reported for women (women (PCC<1mg/l vs PCC≥1mg/l): stress MBF = 3.3±0.6 vs. 3.0±0.8 ml/g/min, P = 0.07; MFR = 3.7±0.6 vs. 3.5±1.0, P = 0.35; Men (PCC<1mg/l vs PCC≥1mg/l): stress MBF= 2.7±0.7 vs. 2.1±1.0 ml/g/min, P = 0.005, MFR = 3.8±1.0 vs. 3.1±1.4, P = 0.018). Significant differences in the stress MBF were observed for the two genders (both p≤0.001), while similar MFR were reported (both p≥0.12). Conclusion: Associations between increases in PCC and reductions in stress MBF and MFR were observed for men, while women did not have the same hemodynamic response. Stress MBF was affected at lower plasma caffeine concentrations in men than women.
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Affiliation(s)
| | | | | | | | | | | | - Andreas Kjaer
- Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Hasbak
- Rigshospitalet,Copenhagen University Hospital, Denmark
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Kitkungvan D, Johnson NP, Kirkeeide R, Haynie M, Carter C, Patel MB, Bui L, Madjid M, Mendoza P, Roby AE, Hood S, Zhu H, Lai D, Sdringola S, Gould KL. Design and rationale of the randomized trial of comprehensive lifestyle modification, optimal pharmacological treatment and utilizing PET imaging for quantifying and managing stable coronary artery disease (the CENTURY study). Am Heart J 2021; 237:135-146. [PMID: 33762179 DOI: 10.1016/j.ahj.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The literature reports no randomized trial in chronic coronary artery disease (CAD) of a comprehensive management strategy integrating intense lifestyle management, maximal medical treatment to specific goals and high precision quantitative cardiac positron emission tomography (PET) for identifying high mortality risk patients needing essential invasive procedures. We hypothesize that this comprehensive strategy achieves greater risk factor reduction, lower major adverse cardiovascular events and fewer invasive procedures than standard practice. METHODS The CENTURY Study (NCT00756379) is a randomized-controlled-trial study in patients with stable or at high risk for CAD. Patients are randomized to standard of care (Standard group) or intense comprehensive lifestyle-medical treatment to targets and PET guided interventions (Comprehensive group). Comprehensive Group patients are regularly consulted by the CENTURY team implementing diet/lifestyle/exercise program and medical treatment to target risk modification. Cardiac PET at baseline, 24-, and 60-months quantify the physiologic severity of CAD and guide interventions in the Comprehensive group while patients and referring physicians of the Standard group are blinded to PET results. The primary end-point is the CENTURY risk score reduction during 5 years follow-up. The secondary endpoint is a composite of death, non-fatal myocardial infarction, stroke, and coronary revascularization. CONCLUSIONS The CENTURY Study is the first study in stable CAD to test the incremental benefit of a comprehensive strategy integrating intense lifestyle modification, medical treatment to specific goals, and high-precision quantitative myocardial perfusion imaging to guide revascularization. A total of 1028 patients have been randomized, and the 5 years follow-up will conclude in 2022.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Nils P Johnson
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Richard Kirkeeide
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Mary Haynie
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Catharine Carter
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Monica B Patel
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Mohammad Madjid
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Patricia Mendoza
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Amanda E Roby
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Susan Hood
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX
| | - Hongjian Zhu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas, Houston, TX
| | - Dejian Lai
- Department of Biostatistics and Data Science, School of Public Health, University of Texas, Houston, TX
| | - Stefano Sdringola
- Division of Cardiology, McGovern Medical School, University of Texas, Houston, TX
| | - Kenneth Lance Gould
- PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas, Houston, TX.
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Gould KL, Bui L, Kitkungvan D, Patel MB. Reliability and Reproducibility of Absolute Myocardial Blood Flow: Does It Depend on the PET/CT Technology, the Vasodilator, and/or the Software? Curr Cardiol Rep 2021; 23:12. [PMID: 33483794 PMCID: PMC7822783 DOI: 10.1007/s11886-021-01449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE OF REVIEW The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? RECENT FINDINGS Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull's-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
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Affiliation(s)
- K. Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Monica B. Patel
- Division of Cardiology, McGovern Medical School, Houston, TX USA
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El-Tallawi KC, Aljizeeri A, Nabi F, Al-Mallah MH. Myocardial Perfusion Imaging Using Positron Emission Tomography. Methodist Debakey Cardiovasc J 2020; 16:114-121. [PMID: 32670471 PMCID: PMC7350808 DOI: 10.14797/mdcj-16-2-114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary artery disease (CAD), also known as ischemic heart disease, is a major cause of morbidity and mortality worldwide, and timely noninvasive diagnosis of clinical and subclinical CAD is imperative to mitigate its burden on individual patients and populations. Positron emission tomography (PET) is a versatile tool that can perform relative myocardial perfusion imaging (MPI) with high accuracy; furthermore, it provides valuable information about the coronary microvasculature using rest and stress myocardial blood flow (MBF) and coronary flow reserve (CFR) measurements. Several radiotracers are approved by the US Food and Drug Administration to help with MPI, MBF, and CFR evaluation. A large body of evidence indicates that evaluation of the coronary microcirculation using MBF and CFR provides strong diagnostic and prognostic data in a multitude of patient populations. This review describes the technical aspects of PET compared to other modalities and discusses its clinical uses for diagnosis and prognosis of coronary arterial epicardial and microcirculatory disease.
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Affiliation(s)
- K Carlos El-Tallawi
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | | | - Faisal Nabi
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mouaz H Al-Mallah
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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