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Whittington B, Dweck MR, van Beek EJR, Newby D, Williams MC. PET-MRI of Coronary Artery Disease. J Magn Reson Imaging 2023; 57:1301-1311. [PMID: 36524452 DOI: 10.1002/jmri.28554] [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: 05/10/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Simultaneous positron emission tomography and magnetic resonance imaging (PET-MRI) combines the anatomical detail and tissue characterization of MRI with the functional information from PET. Within the coronary arteries, this hybrid technique can be used to identify biological activity combined with anatomically high-risk plaque features to better understand the processes underlying coronary atherosclerosis. Furthermore, the downstream effects of coronary artery disease on the myocardium can be characterized by providing information on myocardial perfusion, viability, and function. This review will describe the current capabilities of PET-MRI in coronary artery disease and discuss the limitations and future directions of this emerging technique. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Beth Whittington
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | | | - David Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Michelle C Williams
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
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2
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Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol 2022; 348:1-8. [PMID: 34902504 PMCID: PMC8779638 DOI: 10.1016/j.ijcard.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
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QRS score: A simple marker to quantify the extent of myocardial scarring in patients with chronic total arterial occlusion. Chronic Dis Transl Med 2021; 8:51-58. [PMID: 35620157 PMCID: PMC9128557 DOI: 10.1016/j.cdtm.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
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Nazir MS, Ismail TF, Reyes E, Chiribiri A, Kaufmann PA, Plein S. Hybrid positron emission tomography-magnetic resonance of the heart: current state of the art and future applications. Eur Heart J Cardiovasc Imaging 2018; 19:962-974. [PMID: 30010838 PMCID: PMC6102801 DOI: 10.1093/ehjci/jey090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/11/2018] [Accepted: 06/12/2018] [Indexed: 02/07/2023] Open
Abstract
Hybrid positron emission tomography-magnetic resonance (PET-MR) imaging is a novel imaging modality with emerging applications for cardiovascular disease. PET-MR aims to combine the high-spatial resolution morphological and functional assessment afforded by magnetic resonance imaging (MRI) with the ability of positron emission tomography (PET) for quantification of metabolism, perfusion, and inflammation. The fusion of these two modalities into a single imaging platform not only represents an opportunity to acquire complementary information from a single scan, but also allows motion correction for PET with reduction in ionising radiation. This article presents a brief overview of PET-MR technology followed by a review of the published literature on the clinical cardio-vascular applications of PET and MRI performed separately and with hybrid PET-MR.
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Affiliation(s)
- Muhummad Sohaib Nazir
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Tevfik F Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Eliana Reyes
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, Zurich, Switzerland
| | - Sven Plein
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, Clarendon Way, University of Leeds, Leeds, UK
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Ziadi MC. Myocardial flow reserve (MFR) with positron emission tomography (PET)/computed tomography (CT): clinical impact in diagnosis and prognosis. Cardiovasc Diagn Ther 2017; 7:206-218. [PMID: 28540215 DOI: 10.21037/cdt.2017.04.10] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In recent years, radionuclide myocardial perfusion imaging (MPI) using positron emission tomography/computed tomography (PET/CT) has emerged as a robust tool for the diagnosis, risk stratification and management of patients with known or established coronary artery disease (CAD). Cardiac PET/CT imaging affords key advantages compared to single photon emission computed tomography (SPECT) that encompass: (I) improved diagnostic accuracy; (II) decreased radiation exposure due to the utilization of short-lived radiopharmaceuticals, and importantly; (III) the ability to quantify noninvasively myocardial blood flow (MBF) in absolute terms, that is in ml per minute per gram of tissue. Quantitative approaches that measure MBF with PET can facilitate the diagnosis of multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. The aim of this review is to focus on the potential clinical utility of MBF and will discuss: (I) basics aspects of PET clinical perfusion tracers and flow quantification parameters; (II) limitations of relative MPI, (III) summarize a classification of diseases where flow quantification may be of use; (IV) specifically, review data on the diagnosis and prognostic value of flow quantification.
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Affiliation(s)
- Maria Cecilia Ziadi
- Non-Invasive Cardiovascular Imaging Department, Diagnóstico Médico Oroño, Rosario, Santa Fe, Argentina
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Weintraub WS, Garratt KN. Should Chronic Total Occlusion Be Treated With Coronary Artery Bypass Grafting? Chronic Total Occlusion Should Not Routinely Be Treated With Coronary Artery Bypass Grafting. Circulation 2016; 133:1818-25. [PMID: 27143549 DOI: 10.1161/circulationaha.115.017798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pauw MD, Melin J, Buyzere MD, Heyndrickx GR. Myocardial oxidative metabolism, blood flow and efficiency in rapid pacing induced heart failure in dogs. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2014; 6:209-215. [PMID: 25755842 PMCID: PMC4348705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Heart failure is the final common pathway for most forms of heart disease, and is characterized by a reduced energy status. Myocardial oxygen consumption (MV02) is closely related to the main determinants of systolic function (heart rate, pressure and contractility). The aim of the study was to compare myocardial blood flow, metabolism and mechanical efficiency in rapid pacing induced heart failure in dogs. METHODS 5 dogs were paced for 3 weeks at 240 bpm, with regular follow up of hemodynamic characteristics. Coronary blood flow and oxidative metabolism were evaluated with [(15)O] water and [(11)C]acetate clearance respectively, in baseline conditions (B) and after 3 weeks of rapid pacing (3 wk RP) using positron emission tomography. RESULTS Three weeks of rapid pacing in a dog model resulted in a severely depressed left ventricular function (LV dP/dtmax 3698 ± 314 mmHg (B) vs. 1365 ± 103 mmHg (3 wk RP)). On the contrary myocardial blood flow 1.29 ± 0.11 ml/min/g (B) vs. 1.05 ± 0.07 ml/min/g (3 wk RP) and oxidative metabolism 0.178 ± 0.1 min(-1) (B) vs. 0.161 ± 0.1 min(-1) (3 wk RP) remained essentially unchanged, indicating a reduced efficiency and a change in O2 utilization. CONCLUSIONS Heart failure induced by rapid ventricular pacing in dogs provokes a clearly reduced mechanical efficiency, illustrating the occurrence of a metabolic remodeling in heart failure induced by rapid pacing.
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Affiliation(s)
- Michel De Pauw
- Department of Cardiology, Ghent University HospitalGhent, Belgium
| | - Jacques Melin
- University of Louvain Medical School BrusselsBrussels, Belgium
| | - Marc De Buyzere
- Department of Cardiology, Ghent University HospitalGhent, Belgium
| | - Guy R Heyndrickx
- University of Louvain Medical School BrusselsBrussels, Belgium
- Cardiovascular Center AalstAalst, Belgium
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Lim SP, Mc Ardle BA, Beanlands RS, Hessian RC. Myocardial Viability: It is Still Alive. Semin Nucl Med 2014; 44:358-74. [DOI: 10.1053/j.semnuclmed.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Intrabone transplant of cord blood stem cells establishes a local engraftment store: a functional PET/FDG study. J Biomed Biotechnol 2012; 2012:767369. [PMID: 23093864 PMCID: PMC3471032 DOI: 10.1155/2012/767369] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/31/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite advancements in comprehension of molecular mechanisms governing bone marrow (BM) homing of hematopoietic stem cells, cord blood transplant (CBT) suffers from a slow rate of hematopoietic recovery. Intrabone (i.b.) injection has been proposed as a method able to improve speed of BM engraftment with respect to conventional i.v. protocols. However, the mechanisms underlying this benefit are largely unknown. AIM To verify whether i.b.-CBT determines a local engraftment able to predict the reconstitution of recipient hematopoiesis. DESIGN AND METHODS Twenty-one patients with hematologic malignancies received i.b. injection into both iliac crests of 3.2 ± 0.68 ∗ 107/kg cord blood cells. One month following i.b.-CBT, PET-CT imaging was performed. Maximal standardized uptake values (SUVs) were assessed in BM of both iliac crests and in all lumbar vertebrae. RESULTS Maximal SUV within iliac crests was higher than in lumbar vertebrae (4.1 ± 1.7 versus 3.2 ± 0.7, resp., P = 0.01). However, metabolic activity in these two different BM districts was significantly correlated (r = 0.7, P < 0.001). Moreover, FDG uptake values within the injection site closely predicted platelet recovery 100 days after i.b.-CBT (r = 0.72, P < 0.01). CONCLUSIONS The metabolic activity of injected BM predicts the subsequent rate of hematopoietic recovery after i.b.-CBT, suggesting a pivotal role of the local engraftment in the reconstitution of recipient hematopoiesis.
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Daniels S, Tohid SFM, Velanguparackel W, Westwell AD. The role and future potential of fluorinated biomarkers in positron emission tomography. Expert Opin Drug Discov 2010; 5:291-304. [DOI: 10.1517/17460441003652967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Knaapen P, de Haan S, Hoekstra O, Halbmeijer R, Appelman Y, Groothuis J, Comans E, Meijerink M, Lammertsma A, Lubberink M, Götte M, van Rossum A. Cardiac PET-CT: advanced hybrid imaging for the detection of coronary artery disease. Neth Heart J 2010; 18:90-8. [PMID: 20200615 PMCID: PMC2828569 DOI: 10.1007/bf03091744] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hybrid imaging of positron emission tomography (PET) together with computed tomography (CT) is rapidly emerging. In cardiology, this new advanced hybrid imaging modality allows quantification of cardiac perfusion in combination with assessment of coronary anatomy within a single scanning session of less than 45 minutes. The near-simultaneous anatomical evaluation of coronary arteries using CT and corresponding functional status using PET provides a wealth of complementary information in patients who are being evaluated for (suspected) coronary artery disease, and could help guide clinical patient management in a novel manner. Clinical experience gained with this recently introduced advanced hybrid imaging tool, however, is still limited and its implementation into daily clinical practice remains largely unchartered territory. This review discusses principles of perfusion PET, its diagnostic accuracy, and potential clinical applications of cardiac PET-CT in patients with ischaemic heart disease. (Neth Heart J 2010;18:90-8.).
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Affiliation(s)
- P. Knaapen
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - S. de Haan
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - O.S. Hoekstra
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - R. Halbmeijer
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Y.E. Appelman
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - J.G.J. Groothuis
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - E.F. Comans
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.R. Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.A. Lammertsma
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M. Lubberink
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M.J.W. Götte
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | - A.C. van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
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12
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The case for myocardial ischemia in hypertrophic cardiomyopathy. J Am Coll Cardiol 2009; 54:866-75. [PMID: 19695469 DOI: 10.1016/j.jacc.2009.04.072] [Citation(s) in RCA: 193] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 04/20/2009] [Accepted: 04/21/2009] [Indexed: 02/07/2023]
Abstract
Since its original description 50 years ago, myocardial ischemia has been a recognized but underappreciated aspect of the pathophysiology of hypertrophic cardiomyopathy (HCM). Nevertheless, the assessment of myocardial ischemia is still not part of routine clinical diagnostic or management strategies. Morphologic abnormalities of the intramural coronary arterioles represent the primary morphologic substrate for microvascular dysfunction and its functional consequence-that is, blunted myocardial blood flow (MBF) during stress. Recently, a number of studies using contemporary cardiovascular imaging modalities such as positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) have led to an enhanced understanding of the role that myocardial ischemia and its sequelae fibrosis play on clinical outcome. In this regard, studies with PET have shown that HCM patients have impaired MBF after dipyridamole infusion and that this blunted MBF is a powerful independent predictor of cardiovascular mortality and adverse LV remodeling associated with LV systolic dysfunction. Stress CMR with late gadolinium enhancement (LGE) has also shown that MBF is reduced in relation to magnitude of wall thickness and in those LV segments occupied by LGE (i.e., fibrosis). These CMR observations show an association between ischemia, myocardial fibrosis, and LV remodeling, providing support that abnormal MBF caused by microvascular dysfunction is responsible for myocardial ischemia-mediated myocyte death, and ultimately replacement fibrosis. Efforts should now focus on detecting myocardial ischemia before adverse LV remodeling begins, so that interventional treatment strategies can be initiated earlier in the clinical course to mitigate ischemia and beneficially alter the natural history of HCM.
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Feola M, Chauvie S, Rosso GL, Biggi A, Ribichini F, Bobbio M. Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study. J Nucl Cardiol 2008. [PMID: 18984457 DOI: 10.1016/j.nuclcard.2008.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The precise etiology of takotsubo cardiomyopathy remains unclear. The study of myocardial blood flow (MBF) and coronary flow reserve (CFR) by use of positron emission tomography might help in understanding this syndrome. METHODS AND RESULTS Three postmenopausal women underwent adenosine/rest perfusion with nitrogen 13 ammonia and metabolism with fluorine 18 fluorodeoxyglucose positron emission tomography, coronary angiography, cardiac magnetic resonance, and echocardiography in the acute phase of takotsubo cardiomyopathy and at 3 months' follow-up, after normalization of left ventricular function. PET study was performed in 2 parts: the perfusion analysis with nitrogen ammonia and the metabolism of the heart using FDG. MBF and CFR were analyzed quantitatively in the acute phase and at follow-up. The images highlighted the impairment of tissue metabolism in the dysfunctioning left ventricular segments in the acute phase, mainly in the apical segments and progressively less in the medium segments. At the same time, a clear inverse metabolic/perfusion mismatch emerged, which normalized 3 months later. The quantitative analysis of MBF showed a reduction in the acute phase in apical segments in comparison to basal segments without differences between midventricular and basal segments. In the acute phase CFR proved to be reduced in apical versus basal segments. CFR impairment of apical segments recovered completely after 3 months. CONCLUSION The acute phase of takotsubo cardiomyopathy is characterized by an inverse perfusion/metabolism mismatch with a reduction in CFR in the apical segments. However, the impairment of CFR and the reduction of metabolism in the apical segments recovered completely after 3 months.
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Affiliation(s)
- Mauro Feola
- Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Cuneo, Italy.
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Feola M, Chauvie S, Rosso GL, Biggi A, Ribichini F, Bobbio M. Reversible impairment of coronary flow reserve in takotsubo cardiomyopathy: a myocardial PET study. J Nucl Cardiol 2008; 15:811-7. [PMID: 18984457 DOI: 10.1007/bf03007363] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/01/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND The precise etiology of takotsubo cardiomyopathy remains unclear. The study of myocardial blood flow (MBF) and coronary flow reserve (CFR) by use of positron emission tomography might help in understanding this syndrome. METHODS AND RESULTS Three postmenopausal women underwent adenosine/rest perfusion with nitrogen 13 ammonia and metabolism with fluorine 18 fluorodeoxyglucose positron emission tomography, coronary angiography, cardiac magnetic resonance, and echocardiography in the acute phase of takotsubo cardiomyopathy and at 3 months' follow-up, after normalization of left ventricular function. PET study was performed in 2 parts: the perfusion analysis with nitrogen ammonia and the metabolism of the heart using FDG. MBF and CFR were analyzed quantitatively in the acute phase and at follow-up. The images highlighted the impairment of tissue metabolism in the dysfunctioning left ventricular segments in the acute phase, mainly in the apical segments and progressively less in the medium segments. At the same time, a clear inverse metabolic/perfusion mismatch emerged, which normalized 3 months later. The quantitative analysis of MBF showed a reduction in the acute phase in apical segments in comparison to basal segments without differences between midventricular and basal segments. In the acute phase CFR proved to be reduced in apical versus basal segments. CFR impairment of apical segments recovered completely after 3 months. CONCLUSION The acute phase of takotsubo cardiomyopathy is characterized by an inverse perfusion/metabolism mismatch with a reduction in CFR in the apical segments. However, the impairment of CFR and the reduction of metabolism in the apical segments recovered completely after 3 months.
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Affiliation(s)
- Mauro Feola
- Department of Cardiovascular Diseases, Ospedale Santa Croce-Carle Cuneo, Cuneo, Italy.
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Knaapen P, Lubberink M. Cardiac positron emission tomography: myocardial perfusion and metabolism in clinical practice. Clin Res Cardiol 2008; 97:791-6. [DOI: 10.1007/s00392-008-0662-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 03/26/2008] [Indexed: 10/22/2022]
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Lortie M, Beanlands RSB, Yoshinaga K, Klein R, Dasilva JN, DeKemp RA. Quantification of myocardial blood flow with 82Rb dynamic PET imaging. Eur J Nucl Med Mol Imaging 2007; 34:1765-74. [PMID: 17619189 DOI: 10.1007/s00259-007-0478-2] [Citation(s) in RCA: 312] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 04/22/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The PET tracer (82)Rb is commonly used to evaluate regional perfusion defects for the diagnosis of coronary artery disease. There is limited information on the quantification of myocardial blood flow and flow reserve with this tracer. The goal of this study was to investigate the use of a one-compartment model of (82)Rb kinetics for the quantification of myocardial blood flow. METHODS Fourteen healthy volunteers underwent rest and dipyridamole stress imaging with both (13)N-ammonia and (82)Rb within a 2-week interval. Myocardial blood flow was estimated from the time-activity curves measured with (13)N-ammonia using a standard two-compartment model. The uptake parameter of the one-compartment model was estimated from the time-activity curves measured with (82)Rb. To describe the relationship between myocardial blood flow and the uptake parameter, a nonlinear extraction function was fitted to the data. This function was then used to convert estimates of the uptake parameter to flow estimates. The extraction function was validated with an independent data set obtained from 13 subjects with documented evidence of coronary artery disease (CAD). RESULTS The one-compartment model described (82)Rb kinetics very well (median R-square = 0.98). The flow estimates obtained with (82)Rb were well correlated with those obtained with (13)N-ammonia (r = 0.85), and the best-fit line did not differ significantly from the identity line. Data obtained from the subjects with CAD confirmed the validity of the estimated extraction function. CONCLUSION It is possible to obtain accurate estimates of myocardial blood flow and flow reserve with a one-compartment model of (82)Rb kinetics and a nonlinear extraction function.
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Affiliation(s)
- Mireille Lortie
- Cardiac PET Centre, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7, Canada
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Yang Y, Rendig S, Siegel S, Newport DF, Cherry SR. Cardiac PET imaging in mice with simultaneous cardiac and respiratory gating. Phys Med Biol 2005; 50:2979-89. [PMID: 15972975 DOI: 10.1088/0031-9155/50/13/001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gating firmware and software were developed for the microPET II small animal scanner. The measured cardiac and respiratory signals were collected and converted to TTL gating signals by a Biopac MP150 data acquisition system and sent to microPET II through two BNC connectors on the front panel. During acquisition, the coincidence monitor takes the average of the last eight gate input cycles and inserts this into the list mode data stream on the falling edge of the gating pulse. This value is then used to determine the current time interval of the next gate cycle when the list mode data are sorted into sinograms. The gating firmware and software were validated by an experiment using a rotating point source. Mouse heart (18F-FDG) and bone (18F(-)) imaging was performed with simultaneous cardiac and respiratory gating. It was clearly demonstrated that the contractile function of the mouse heart can be studied by cardiac-gated imaging with microPET II. The left ventricular volumes at different times of the cardiac cycle were measured and the ejection fraction was calculated. In the bone scan, no detectable movement caused by heart contraction was observed. Respiratory motion was more subtle with virtually no motion for more than 75% of the respiratory cycle. The motion of the mouse heart and bones in the thorax caused by respiration was less than 1 mm. It appears with the current resolution of PET, and the small fraction of the respiratory cycle in which motion occurs, that respiratory gating is probably not necessary for most mouse cardiac studies.
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Affiliation(s)
- Yongfeng Yang
- Department of Biomedical Engineering, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
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Camici PG. Coronary microvascular remodeling and ischaemia in hypertension. Am J Cardiovasc Drugs 2004. [DOI: 10.2165/00129784-200404991-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Coma-Canella I, García-Velloso MJ, Macías A, Villar L, Cosín-Sales J, Martí-Climent JM, Artaiz M. [Impaired coronary flow reserve in patients with non-ischemic heart failure]. Rev Esp Cardiol 2003; 56:354-60. [PMID: 12689569 DOI: 10.1016/s0300-8932(03)76878-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary flow reserve (CFR) is impaired not only in ischemic heart disease, but also in cardiac diseases that may or may not course with heart failure. The aim of the present study was to determine if the severity of heart failure can influence CFR impairment. METHODS Forty patients with non-ischemic heart disease and heart failure were studied 41 times. Four groups were established: 1. 10 patients in functional class III-IV; 2. 10 patients in functional class II not taking beta-blockers; 3. 11 patients in class II treated with carvedilol, and 4. 10 patients in class I. These patients had a history of heart failure and systolic dysfunction. Myocardial blood flow (MBF) was measured with positron emission tomography (PET) and N-13 ammonia at rest (r) and during adenosine triphosphate (ATP) infusion. RESULTS MBF and CFR were significantly higher in group 4 (1.95 0.58 and 2.40 0.95 ml/min/g) than in group 1 (1.02 0.52 and 1.46 0.48 ml/min/g). CFR tended to be higher in groups 2 (1.73 0.72), and 3 (1.89 0.75) vs group 1. No significant correlation was found between CFR and the following variables: age, systolic blood pressure, ventricular mass index, ventricular volume indexes, and ejection fraction. CONCLUSIONS Coronary microvascular function is impaired in non-ischemic heart failure, and the impairment is related to functional class, regardless of the underlying responsible heart disease.
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Affiliation(s)
- Isabel Coma-Canella
- Departamento de Cardiología. Clínica Universitaria de Navarra. Facultad de Medicina. Universidad de Navarra. Pamplona, Spain.
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Chamuleau SAJ, van Eck-Smit BLF, Meuwissen M, Piek JJ. Adequate patient selection for coronary revascularization: an overview of current methods used in daily clinical practice. Int J Cardiovasc Imaging 2002; 18:5-15. [PMID: 12135122 DOI: 10.1023/a:1014372125457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Widely used non-invasive stress modalities, like exercise ECG, MPS and stress-echocardiography, are the tests of first choice for the diagnosis of CAD. It has been shown in numerous studies that non-invasive assessment of perfusion abnormalities is an adequate strategy for risk stratification. Moreover, non-invasive stress testing should be performed before a diagnostic cardiac catheterization to document the presence of myocardial ischemia, as a prerequisite for coronary revascularization. Coronary angiography is the gold standard for identifying CAD; however this technique is limited in assessing functional severity of coronary narrowings ('illusion of luminology'; see also Figure 5). The recently introduced i.c. hemodynamic parameters (CFVR and FFR) can identify functional severity of specific lesions and have shown a good agreement with the results of non-invasive stress test in validation studies. Furthermore, there is accumulating evidence that it is safe to defer a PTCA procedure, based on normal FFR and CFVR values. As these indices are derived during an invasive cardiac catheterization procedure, its use is recommended during a so called 'ad hoc' PTCA setting. Furthermore, they are particularly useful for clinical decision making in patients with documented multivessel CAD, as both indices allow selective evaluation of coronary narrowings in different arteries. Revascularization procedures are costly and always have a potential risk. It is important to be aware that, using above mentioned methods, unnecessary interventions (lacking potential benefit) may be avoided.
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Affiliation(s)
- Steven A J Chamuleau
- Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
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