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Wang L, Zheng Y, Zhang J, Wang M, Wu D, Wang Y, Qiu H, Hsu B, Fang W. Diagnostic value of quantitative myocardial blood flow assessment by NaI(Tl) SPECT in detecting significant stenosis: a prospective, multi-center study. J Nucl Cardiol 2023; 30:769-780. [PMID: 35971031 DOI: 10.1007/s12350-022-03085-3] [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: 05/23/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVES The aim of this prospective multi-center study was to investigate the diagnostic value of myocardial blood flow (MBF) quantification using NaI(Tl)-based single-photon emission computed tomography (SPECT) for determining coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). BACKGROUND Absolute quantitation of MBF and myocardial flow reserve (MFR) using SPECT is clinically feasible; however, whether flow quantification using NaI(Tl) SPECT is superior to commonly performed SPECT myocardial perfusion imaging (MPI) in determining CAD has not been evaluated. METHODS Patients with suspected or known CAD underwent pharmacological stress/rest dynamic SPECT imaging and routine SPECT MPI followed by QCA. Obstructive disease was defined as ≥ 50% reduction in luminal diameter on QCA. RESULTS One hundred fifty-four patients (462 vessels) were included in the analysis. Obstructive CAD was detected in 76/154 patients (49.4%) and 112/462 vessels (24.2%). Optimal cut-off values were 1.86 mL/min/g for stress MBF and 1.95 for MFR, respectively. Stress MBF and MFR were more sensitive than MPI in both individual patients (stress MBF vs MPI: 81.6% vs 51.3%; MFR vs MPI: 72.4% vs 51.3%) and in coronary vascular regions (stress MBF vs MPI: 78.6% vs 31.3%; MFR vs MPI: 75.9% vs 31.3%; all P < .01). In receiver operating characteristic curve analysis, quantification revealed a significantly greater area under the curve than MPI at the patient (stress MBF vs MPI: 0.761 vs 0.641; MFR vs MPI: 0.770 vs 0.641) and the vessel (stress MBF vs MPI: 0.745 vs 0.613; MFR vs MPI: 0.756 vs 0.613; all P < .05) levels. Integrating quantitative SPECT measures with MPI significantly increased the area under the curve and improved the discriminatory and reclassification capacity. CONCLUSION Flow quantification using NaI(Tl) SPECT provides superior sensitivity and discriminatory capacity to MPI in detecting significant stenosis. Clinical trial registration NCT03637725.
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Affiliation(s)
- Lei Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Yumin Zheng
- Department of Nuclear Medicine, China-Japan Friendship Hospital, National Center for Respiratory Diseases, Beijing, China
| | - Jie Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Meng Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Dayong Wu
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Yawen Wang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China
| | - Hong Qiu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bailing Hsu
- Nuclear Science and Engineering Institute, University of Missouri-Columbia, Columbia, MO, USA
| | - Wei Fang
- Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, China.
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Nye JA, Piccinelli M, Hwang D, Cooke CD, Paeng JC, Lee JM, Cho SG, Folks R, Haber M, Bom HS, Koo BK, Garcia EV. Determination of [N-13]-ammonia extraction fraction in patients with coronary artery disease by calibration to invasive coronary and fractional flow reserve. J Nucl Cardiol 2022; 29:2210-2219. [PMID: 34036523 PMCID: PMC10630982 DOI: 10.1007/s12350-021-02628-4] [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: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study presents a new extraction fraction (EF) model based on physiological measures of invasive coronary flow reserve (CFR) and fractional flow reserve (FFR) in patients with suspected coronary artery disease (CAD) and normal index microcirculatory resistance (IMR). To ascertain the clinical relevance of the new EFs, flow measurements using the newly patient-determined EFs were compared to flow measurements using traditional animal-determined EFs. METHODS 39 patients were retrospectively selected that included a total of 91 vascular territories with invasive coronary angiography physiological measures. [N-13]-ammonia dynamic rest/adenosine-stress PET imaging was conducted in all patients and absolute myocardial flow was estimated using four published compartmental models. The extraction fraction during hyperemic flow was iteratively estimated by maximizing the agreement between invasive CFR and FFR with the non-invasive analogs myocardial flow reserve (MFR) and relative flow reserve (RFR) at similar physiological states, respectively. RESULTS Using the new patient-determined EFs, agreement between CFR vs MFR for Model 1 and 2 was moderate and poor for Model 3 and 4. All models showed moderate agreement for FFR vs RFR. When using published models of animal-determined EFs, agreement between CFR vs MFR remained moderate for Model 1 and 2, and poor for Model 3 and 4. Similarly, all models showed moderate agreement for FFR vs RFR using animal-determined EF values. None of the observed differences were statistically significant. CONCLUSIONS Flow measurements using extraction fraction correction for [N-13]-ammonia based on calibration to invasive intracoronary angiography physiological measures in patients with CAD were not discordant from those reported in the literature. Either patient-determined or traditional animal-determined EF correction, when used with the appropriate flow model, yields moderate agreement with invasive measurements of coronary flow reserve and fractional flow reserve.
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Affiliation(s)
- Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA.
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
| | - Michael Haber
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Emory University, 1841 Clifton Rd. NE, Atlanta, GA, 30329, USA
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Yamamoto A, Nagao M, Ando K, Nakao R, Sakai A, Watanabe E, Momose M, Sato K, Fukushima K, Sakai S, Hagiwara N. Myocardial Flow Reserve in Coronary Artery Disease with Low Attenuation Plaque: Coronary CTA and 13N-ammonia PET Assessments. Acad Radiol 2022; 29 Suppl 4:S17-S24. [PMID: 33281040 DOI: 10.1016/j.acra.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/31/2022]
Abstract
RATIONALE AND OBJECTIVES Physiological measurements from coronary angiography show that coronary stenosis with necrotic core plaque reduces coronary flow reserve (CFR). Myocardial flow reserve (MFR) estimated by 13N-ammonia PET (NH3-PET) is a different index from CFR. Low attenuation plaque (LAP) on coronary CTA (CCTA) contains necrotic core, but the link between LAP and MFR has not been elucidated. We aimed to investigate the influence of LAP on MFR in coronary artery disease (CAD). MATERIALS AND METHODS The study included 105 consecutive patients who underwent NH3-PET and CCTA within 3 months. Nonevaluable coronary arteries due to severe calcification and stent implants were excluded. Finally, 290 major vessels were retrospectively analyzed. Coronary arteries were divided into mild (1%-49%), moderate (50%-69% stenosis), and severe (≥70% stenosis) groups. Coronary plaques were classified either LAP (including soft tissue CT value <30 HU) or completely classified plaques. MFR for the major vessels were calculated and MFR <2.0 was considered a significant decrease. Comparison of MFR between territories with and without LAP, and the effect of plaque characteristics on MFR was analyzed. RESULTS MFR was significantly lower for territories with LAP than with calcified plaques or no plaque (2.1 ± 0.7, 2.4 ± 0.7, and 2.3 ± 0.7; p < 0.05). There was no difference between calcified plaque and no plaque territories (p = 0.79). Multivariate logistic analysis for plaque characteristics and stenosis severity revealed that LAP and severe stenosis were independent predictors for territories with MFR <2.0 with odds ratios of 3.1 (95% confidence interval, 1.2-8.1) and 3.0 (95% confidence interval, 1.7-5.3). CONCLUSION LAP reduced MFR compared with calcified plaque or no plaque in CAD. LAP is an independent predictor of the territory with MFR <2.0.
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Piccinelli M, Dahiya N, Nye JA, Folks R, Cooke CD, Manatunga D, Hwang D, Paeng JC, Cho SG, Lee JM, Bom HS, Koo BK, Yezzi A, Garcia EV. Clinically viable myocardial CCTA segmentation for measuring vessel-specific myocardial blood flow from dynamic PET/CCTA hybrid fusion. Eur J Hybrid Imaging 2022; 6:4. [PMID: 35165793 PMCID: PMC8844325 DOI: 10.1186/s41824-021-00122-1] [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: 10/20/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Positron emission tomography (PET)-derived LV MBF quantification is usually measured in standard anatomical vascular territories potentially averaging flow from normally perfused tissue with those from areas with abnormal flow supply. Previously we reported on an image-based tool to noninvasively measure absolute myocardial blood flow at locations just below individual epicardial vessel to help guide revascularization. The aim of this work is to determine the robustness of vessel-specific flow measurements (MBFvs) extracted from the fusion of dynamic PET (dPET) with coronary computed tomography angiography (CCTA) myocardial segmentations, using flow measured from the fusion with CCTA manual segmentation as the reference standard. Methods Forty-three patients’ 13NH3 dPET, CCTA image datasets were used to measure the agreement of the MBFvs profiles after the fusion of dPET data with three CCTA anatomical models: (1) a manual model, (2) a fully automated segmented model and (3) a corrected model, where major inaccuracies in the automated segmentation were briefly edited. Pairwise accuracy of the normality/abnormality agreement of flow values along differently extracted vessels was determined by comparing, on a point-by-point basis, each vessel’s flow to corresponding vessels’ normal limits using Dice coefficients (DC) as the metric. Results Of the 43 patients CCTA fully automated mask models, 27 patients’ borders required manual correction before dPET/CCTA image fusion, but this editing process was brief (2–3 min) allowing a 100% success rate of extracting MBFvs in clinically acceptable times. In total, 124 vessels were analyzed after dPET fusion with the manual and corrected CCTA mask models yielding 2225 stress and 2122 rest flow values. Forty-seven vessels were analyzed after fusion with the fully automatic masks producing 840 stress and 825 rest flow samples. All DC coefficients computed globally or by territory were ≥ 0.93. No statistical differences were found in the normal/abnormal flow classifications between manual and corrected or manual and fully automated CCTA masks. Conclusion Fully automated and manually corrected myocardial CCTA segmentation provides anatomical masks in clinically acceptable times for vessel-specific myocardial blood flow measurements using dynamic PET/CCTA image fusion which are not significantly different in flow accuracy and within clinically acceptable processing times compared to fully manually segmented CCTA myocardial masks.
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Park H, Kang DY, Lee CW. Functional Angioplasty: Definitions, Historical Overview, and Future Perspectives. Korean Circ J 2022; 52:34-46. [PMID: 34989193 PMCID: PMC8738709 DOI: 10.4070/kcj.2021.0363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023] Open
Abstract
Myocardial ischemia plays a central role in the pathophysiology of angina pectoris. Percutaneous coronary intervention (PCI) guidance has evolved from anatomic stenosis to physiologic evidence of flow limitation. However, there is no evidence that one guidance is superior to another in improving clinical outcomes after PCI. Hallmarks of inducible ischemia such as electrocardiographic changes and wall motion abnormalities may be more clinically relevant as the reference standard to define ischemia-inducing lesions. Considering all available evidence, PCI should be considered as symptomatic therapy without altering the atherosclerotic process, and reserved for patients with inducible ischemia who are non-responsive to medical therapy. Percutaneous coronary intervention (PCI) is used to treat obstructive coronary artery disease (CAD). The role of PCI is well defined in acute coronary syndrome, but that for stable CAD remains debatable. Although PCI generally relieves angina in patients with stable CAD, it may not change its prognosis. The extent and severity of CAD are major determinants of prognosis, and complete revascularization (CR) of all ischemia-causing lesions might improve outcomes. Several studies have shown better outcomes with CR than with incomplete revascularization, emphasizing the importance of functional angioplasty. However, different definitions of inducible myocardial ischemia have been used across studies, making their comparison difficult. Various diagnostic tools have been used to estimate the presence, extent, and severity of inducible myocardial ischemia. However, to date, there are no agreed reference standards of inducible myocardial ischemia. The hallmarks of inducible myocardial ischemia such as electrocardiographic changes and regional wall motion abnormalities may be more clinically relevant as the reference standard to define ischemia-causing lesions. In this review, we summarize studies regarding myocardial ischemia, PCI guidance, and possible explanations for similar findings across studies. Also, we provide some insights into the ideal definition of inducible myocardial ischemia and highlight the appropriate PCI strategy.
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kawaguchi N, Okayama H, Kido T, Fukuyama N, Shigematsu T, Kawamura G, Hiasa G, Kazatani Y, Inoue T, Miki H, Miyagawa M, Mochizuki T. Clinical significance of corrected relative flow reserve derived from 13N-ammonia positron emission tomography combined with coronary computed tomography angiography. J Nucl Cardiol 2021; 28:1851-1860. [PMID: 31713117 DOI: 10.1007/s12350-019-01931-5] [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: 05/21/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study evaluated corrected relative flow reserve (RFR) derived from 13N-ammonia positron emission tomography (PET) combined with coronary computed tomography angiography (CTA). METHODS We analyzed 61 patients who underwent coronary CTA, 13N-ammonia PET, and invasive coronary angiography. Triple-vessel disease were excluded. Conventional RFRs were calculated as the ratio of hyperemic myocardial blood flow (hMBF) of hypoperfusion areas to those of non-ischemic lesions. Corrected RFRs were calculated using PET and coronary CTA to adjust coronary territories to their feeding vessels. Diagnostic performance was compared to detect obstructive coronary lesions. RESULTS Of the 180 vessels analyzed, 50 were diagnosed as obstructive lesions (≥ 70% stenosis and/or fractional flow reserve value ≤ 0.8). The coronary flow reserve (CFR), hMBF, conventional RFR, and corrected RFR of obstructive lesions were significantly lower than those of non-obstructive lesions. In receiver operating characteristic curve analysis, these quantitative PET measurements had area under the curve of 0.67, 0.71, 0.89, and 0.92, respectively. Diagnostic performance differences between corrected and conventional RFR were not statistically significant. CONCLUSION In patients with single or double vessel disease, indices of RFR, with or without coronary angiographic guidance of the reference coronary territory, are better discriminators of flow-limiting stenoses than hMBF and CFR.
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Affiliation(s)
- Naoto Kawaguchi
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hideki Okayama
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan.
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Naoki Fukuyama
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Tatsuya Shigematsu
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Go Kawamura
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Go Hiasa
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Yukio Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan
| | - Takeshi Inoue
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Hitoshi Miki
- Department of Radiology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Masao Miyagawa
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Manabe O, Aikawa T, Naya M, Miura S, Oyama-Manabe N. Functional Assessment of Coronary Artery Disease by Myocardial Flow Reserve Versus Pressure-wire Based Assessment. ANNALS OF NUCLEAR CARDIOLOGY 2021; 7:57-62. [PMID: 36994131 PMCID: PMC10040938 DOI: 10.17996/anc.21-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
Positron emission tomography (PET) permits the noninvasive quantification of myocardial blood flow (MBF). Myocardial flow reserve (MFR), calculated by dividing stress MBF by rest MBF is a reliable index for the functional information of coronary artery disease. A pressure-derived physiological index, such as fractional flow reserve (FFR) is also an important measurement. Both MFR and FFR values are used to evaluate coronary physiology; however, but they are not interchangeable because each test has certain discrepancies. In this systematic review, we provide an overview of coronary physiology with PET compared to pressure-derived physiological indices.
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Affiliation(s)
- Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center
| | - Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Miura
- Department of Cardiology, Hokkaido Ohno Memorial Hospital
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Cho SG, Kong EJ, Kang WJ, Paeng JC, Bom HSH, Cho I. KSNM60 in Cardiology: Regrowth After a Long Pause. Nucl Med Mol Imaging 2021; 55:151-161. [PMID: 34422125 PMCID: PMC8322215 DOI: 10.1007/s13139-021-00702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/09/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
The Korean Society of Nuclear Medicine (KSNM) is celebrating its 60th anniversary in honor of the nuclear medicine professionals who have dedicated their efforts towards research, academics, and the more comprehensive clinical applications and uses of nuclear imaging modalities. Nuclear cardiology in Korea was at its prime time in the 1990s, but its growth was interrupted by a long pause. Despite the academic and practical challenges, nuclear cardiology in Korea now meets the second leap, attributed to the growth in molecular imaging tailored for many non-coronary diseases and the genuine values of nuclear myocardial perfusion imaging. In this review, we describe the trends, achievements, challenges, and perspectives of nuclear cardiology throughout the 60-year history of the KSNM.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Jung Kong
- Department of Nuclear Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Seung Henry Bom
- 5Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Ihnho Cho
- Department of Nuclear Medicine, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415 Republic of Korea
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Nye JA, Piccinelli M, Hwang D, David Cooke C, Paeng JC, Lee JM, Cho SG, Folks R, Bom HS, Koo BK, Garcia EV. Dynamic cardiac PET motion correction using 3D normalized gradient fields in patients and phantom simulations. Med Phys 2021; 48:5072-5084. [PMID: 34174095 DOI: 10.1002/mp.15059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022] Open
Abstract
This work expands on the implementation of three-dimensional (3D) normalized gradient fields to correct for whole-body motion and cardiac creep in [N-13]-ammonia patient studies and evaluates its accuracy using a dynamic phantom simulation model. METHODS A full rigid-body algorithm was developed using 3D normalized gradient fields including a multi-resolution step and sampling off the voxel grid to reduce interpolation artifacts. Optimization was performed using a weighted similarity metric that accounts for opposing gradients between images of blood pool and perfused tissue without the need for segmentation. Forty-three retrospective dynamic [N-13]-ammonia PET/CT rest/adenosine-stress patient studies were motion corrected and the mean motion parameters plotted at each frame time point. Motion correction accuracy was assessed using a comprehensive dynamic XCAT simulation incorporating published physiologic parameters of the heart's trajectory following adenosine infusion as well as corrupted attenuation correction commonly observed in clinical studies. Accuracy of the algorithm was assessed objectively by comparing the errors between isosurfaces and centers of mass of the motion corrected XCAT simulations. RESULTS In the patient studies, the overall mean cranial-to-caudal translation was 7 mm at stress over the duration of the adenosine infusion. Noninvasive clinical measures of relative flow reserve and myocardial flow reserve were highly correlated with their invasive analogues. Motion correction accuracy assessed with the XCAT simulations showed an error of <1 mm in late perfusion frames that broadened gradually to <3 mm in earlier frames containing blood pool. CONCLUSION This work demonstrates that patients undergoing [N-13]-ammonia dynamic PET/CT exhibit a large cranial-to-caudal translation related to cardiac creep primarily at stress and to a lesser extent at rest, which can be accurately corrected by optimizing their 3D normalized gradient fields. Our approach provides a solution to the challenging condition where the image intensity and its gradients are opposed without the need for segmentation and remains robust in the presence of PET-CT mismatch.
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Affiliation(s)
- Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Charles David Cooke
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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Nammas W, Maaniitty T, Knuuti J, Saraste A. Cardiac perfusion by positron emission tomography. Clin Physiol Funct Imaging 2021; 41:385-400. [PMID: 33969615 DOI: 10.1111/cpf.12708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/05/2021] [Indexed: 01/16/2023]
Abstract
Myocardial perfusion imaging (MPI) with positron emission tomography (PET) is an established tool for evaluation of obstructive coronary artery disease (CAD). The contemporary 3-dimensional scanner technology and the state-of-the-art MPI radionuclide tracers and pharmacological stress agents, as well as the cutting-edge image reconstruction techniques and data analysis software, have all enabled accurate, reliable and reproducible quantification of absolute myocardial blood flow (MBF), and henceforth calculation of myocardial flow reserve (MFR) in several clinical scenarios. In patients with suspected coronary artery disease, both absolute stress MBF and MFR can identify myocardial territories subtended by epicardial coronary arteries with haemodynamically significant stenosis, as defined by invasive coronary fractional flow reserve measurement. In particular, absolute stress MBF and MFR offered incremental prognostic information for predicting adverse cardiac outcome, and hence for better patient risk stratification, over those provided by traditional clinical risk predictors. This article reviews the available evidence to support the translation of the current techniques and technologies into a useful decision-making tool in real-world clinical practice.
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Affiliation(s)
- Wail Nammas
- Heart Center, Turku University Hospital, Turku, Finland
| | - Teemu Maaniitty
- PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhani Knuuti
- PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland.,PET Centre, Turku University Hospital and University of Turku, Turku, Finland
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Patel KK, Spertus JA, Chan PS, Sperry BW, Al Badarin F, Kennedy KF, Thompson RC, Case JA, McGhie AI, Bateman TM. Myocardial blood flow reserve assessed by positron emission tomography myocardial perfusion imaging identifies patients with a survival benefit from early revascularization. Eur Heart J 2021; 41:759-768. [PMID: 31228200 DOI: 10.1093/eurheartj/ehz389] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/13/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023] Open
Abstract
AIMS Positron emission tomography (PET) myocardial perfusion imaging (MPI) can non-invasively measure myocardial blood flow reserve (MBFR). We aimed to examine whether MBFR identifies patients with a survival benefit after revascularization, helping to guide post-test management. METHODS AND RESULTS We examined all-cause mortality in 12 594 consecutive patients undergoing Rb82 rest/stress PET MPI from January 2010 to December 2016, after excluding those with cardiomyopathy, prior coronary artery bypass surgery (CABG), and missing MBFR. Myocardial blood flow reserve was calculated as the ratio of stress to rest absolute myocardial blood flow. A Cox model adjusted for patient and test characteristics, early revascularization (percutaneous coronary intervention or CABG ≤90 days of MPI), and the interaction between MBFR and early revascularization was developed to identify predictors of all-cause mortality. After a median follow-up of 3.2 years, 897 patients (7.1%) underwent early revascularization and 1699 patients (13.5%) died. Ischaemia was present in 4051 (32.3%) patients, with 1413 (11.2%) having ≥10% ischaemia. Mean MBFR was 2.0 ± 1.3, with MBFR <1.8 in 4836 (38.5%). After multivariable adjustment, every 0.1 unit decrease in MBFR was associated with 9% greater hazard of all-cause death (hazard ratio 1.09, 95% confidence interval 1.08-1.10; P < 0.001). There was a significant interaction between MBFR and early revascularization (P < 0.001); such that patients with MBFR ≤1.8 had a survival benefit with early revascularization, regardless of type of revascularization or level of ischaemia. CONCLUSION Myocardial blood flow reserve on PET MPI is associated with all-cause mortality and can identify patients who receive a survival benefit with early revascularization compared to medical therapy. This may be used to guide revascularization, and prospective validation is needed.
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Affiliation(s)
- Krishna K Patel
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - John A Spertus
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Paul S Chan
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Brett W Sperry
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Firas Al Badarin
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Randall C Thompson
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - James A Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - A Iain McGhie
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
| | - Timothy M Bateman
- Department of Cardiology, University of Missouri - Kansas City, Kansas City, MO 64111, USA.,Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, 9th floor CV Research, Kansas City, MO 64111, USA
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12
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Bateman TM, Heller GV, Beanlands R, Calnon DA, Case J, deKemp R, Gordon DePuey E, Di Carli M, Guler EC, Murthy VL, Rosenblatt J, Sher R, Slomka P, Ruddy TD. Practical guide for interpreting and reporting cardiac PET measurements of myocardial blood flow: an Information Statement from the American Society of Nuclear Cardiology, and the Society of Nuclear Medicine and Molecular Imaging. J Nucl Cardiol 2021; 28:768-787. [PMID: 33786730 DOI: 10.1007/s12350-021-02552-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/22/2023]
Affiliation(s)
- Timothy M Bateman
- Saint-Luke's Mid America Heart Institute and the University of Missouri - Kansas City, 4320 Wornall Road, Suite 2000, Kansas City, MO, USA.
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Rob Beanlands
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Dennis A Calnon
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, USA
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, USA
| | - Rob deKemp
- University of Ottawa Heart Institute, Ottawa, Canada
| | - E Gordon DePuey
- Icahn School of Medicine, Mount Sinai, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Marcelo Di Carli
- Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emel C Guler
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Piotr Slomka
- Cedars Sinai Medical Center, Los Angeles, CA, USA
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13
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Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR-The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study. J Interv Cardiol 2021; 2021:5522707. [PMID: 34007248 PMCID: PMC8026323 DOI: 10.1155/2021/5522707] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P < 0.001) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.
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14
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Bateman TM, Heller GV, Beanlands R, Calnon DA, Case J, deKemp R, DePuey EG, Di Carli M, Guler EC, Murthy VL, Rosenblatt J, Sher R, Slomka P, Ruddy TD. Practical guide for interpreting and reporting cardiac PET measurements of myocardial blood flow: an Information Statement from the American Society of Nuclear Cardiology, and the Society of Nuclear Medicine and Molecular Imaging. J Nucl Med 2021; 62:1599-1615. [PMID: 33789935 DOI: 10.2967/jnumed.121.261989] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Timothy M Bateman
- Saint-Luke's Mid America Heart Institute and the University of Missouri - Kansas City, Kansas City, MO, United States
| | - Gary V Heller
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, United States
| | - Rob Beanlands
- University of Ottawa Heart Institute, Ottawa, Canada, Canada
| | - Dennis A Calnon
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus, OH, United States
| | - James Case
- Cardiovascular Imaging Technologies, Kansas City, MO, United States
| | - Rob deKemp
- University of Ottawa Heart Institute, Ottawa, Canada, Canada
| | - E Gordon DePuey
- Icahn School of Medicine, Mount Sinai, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Marcelo Di Carli
- Nuclear Medicine and Molecular Imaging, Department of Radiology; and Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Emel C Guler
- University of Ottawa Heart Institute, Ottawa, Canada, Canada
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States
| | | | - Ronald Sher
- Clinical Associates, Reisterstown, MD, United States
| | - Piotr Slomka
- Cedars Sinai Medical Center, Los Angeles, CA, United States
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15
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Kiko T, Yokokawa T, Masuda A, Misaka T, Yamada S, Kaneshiro T, Oikawa M, Yoshihisa A, Nakazato K, Takeishi Y. Simultaneous assessment of coronary flow reserve and left ventricular function during vasodilator stress evaluated by 13N-ammonia hybrid PET/MRI. Clin Radiol 2021; 76:472.e1-472.e9. [PMID: 33752883 DOI: 10.1016/j.crad.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
AIM To explore changes in left ventricular (LV) function and the relationship of these changes with myocardial blood flow (MBF) evaluated by 13N-ammonia hybrid positron-emission tomography (PET)/magnetic resonance imaging (MRI) during vasodilator stress in patients with suspected coronary artery disease (CAD). MATERIALS AND METHODS Fifty-two consecutive patients with suspected CAD, who underwent 13N-ammonia PET/MRI, were enrolled. Vasodilator stress was induced by intravenous injection of adenosine. MBF and coronary flow reserve (CFR) were calculated from dynamic acquisition of 13N-ammonia PET. LV function was evaluated by MRI both at rest and during vasodilator stress. An abnormal perfusion on myocardial images was defined as a summed difference score of ≥4. RESULTS MRI showed that the LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction (LVEF) remained unchanged during vasodilator stress in all patients (n=52) as well as in the patients with CFR of <2 (n=27), stress MBF of <1.3 ml/g/min (n=28), abnormal myocardial perfusion (n=30), and more than one diseased vessel (n=46). In only four patients, the LVEF measured by MRI decreased by >5% during vasodilator stress. In these four patients, CFR was lower (1.57 ± 0.12 versus 2.18 ± 0.86, p<0.01) and the number of diseased vessels was higher (2.75 ± 0.50 versus 1.48 ± 0.92, p<0.01) than in patients without post-stress LV dysfunction. CONCLUSION The LV volume and systolic function evaluated by cardiac MRI remained unchanged during vasodilator stress; however, LV dysfunction during vasodilator stress may occur in patients with severe CAD.
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Affiliation(s)
- T Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan.
| | - T Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - A Masuda
- Department of Diagnostic Radiology, Tohoku University Hospital, Japan
| | - T Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - S Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - T Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - M Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - A Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - K Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Y Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
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16
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Benz DC, Ferro P, Safa N, Messerli M, von Felten E, Huang W, Patriki D, Giannopoulos AA, Fuchs TA, Gräni C, Gebhard C, Pazhenkottil AP, Kaufmann PA, Buechel RR. Role of quantitative myocardial blood flow and 13N-ammonia washout for viability assessment in ischemic cardiomyopathy. J Nucl Cardiol 2021; 28:263-273. [PMID: 30895563 DOI: 10.1007/s12350-019-01684-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Positron emission tomography (PET) integrating assessment of perfusion with 13N-ammonia (NH3) and viability with 18F-fluorodeoxyglucose (FDG) has high accuracy to identify viable, hibernating myocardium. We tested whether quantification of myocardial blood flow (MBF) and washout (k2) can predict myocardial viability using FDG as standard of reference. METHODS In 180 consecutive patients with ischemic cardiomyopathy, myocardium was categorized on a segment-level into normal, ischemic, hibernating, and scar. From dynamic images, stress MBF, rest MBF, and k2 were derived and myocardial flow reserve (MFR) and volume of distribution (VD) were calculated. RESULTS Across myocardial tissues, all parameters differed significantly. The area under the curve (AUC) was 0.564 (95% CI 0.527-0.601), 0.635 (0.599-0.671), 0.553 (0.516-0.591), 0.520 (0.482-0.559), and 0.560 (0.522-0.597) for stress MBF, rest MBF, MFR, k2, and VD. The generalized linear mixed model correctly classified 81% of scar as viable, hibernating myocardium. If the threshold of rest MBF to predict viability was set to 0.45 mL·min-1·g-1, sensitivity and specificity were 96% and 12%, respectively. CONCLUSION Quantitative NH3 PET parameters have low to moderate diagnostic performance to predict viability in ischemic cardiomyopathy. However, if rest MBF falls below 0.45 mL·min-1·g-1, viability testing by FDG-PET may be safely deferred.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Nico Safa
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Wenjie Huang
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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17
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Dai N, Hwang D, Lee JM, Zhang J, Tong Y, Jeon KH, Paeng JC, Cheon GJ, Koo BK, Ge J. Association of Quantitative Flow Ratio with Lesion Severity and Its Ability to Discriminate Myocardial Ischemia. Korean Circ J 2021; 51:126-139. [PMID: 33525067 PMCID: PMC7853889 DOI: 10.4070/kcj.2020.0375] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives Quantitative flow ratio (QFR) is an angiography-based technique for functional assessment of coronary artery stenosis. This study investigated the response of QFR to different degree of stenosis severity and its ability to predict the positron emission tomography (PET)-defined myocardial ischemia. Methods From 109 patients with 185 vessels who underwent both 13N-ammonia PET and invasive physiological measurement, we compared QFR, fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) for the responses to the different degree of anatomical (percent diameter stenosis [%DS]) and hemodynamic (relative flow reserve [RFR], coronary flow reserve, hyperemic stenosis resistance, and stress myocardial flow) stenosis severity and diagnostic performance against PET-derived parameters. Results QFR, FFR, and iFR showed similar responses to both anatomic and hemodynamic stenosis severity. Regarding RFR, the diagnostic accuracy of QFR was lower than FFR (76.2% vs. 83.2%, p=0.021) and iFR (76.2% vs. 84.3%, p=0.031). For coronary flow capacity (CFC), QFR showed a lower accuracy than iFR (74.1% vs. 82%, p=0.031) and lower discriminant function than FFR (area under curve: 0.74 vs. 0.79, p=0.044). Discordance between QFR and FFR or iFR was shown in 14.6% of cases and was driven by the difference in %DS and heterogeneous distribution of PET-derived RFR and stress myocardial blood flow. Conclusions QFR demonstrated a similar response to different anatomic and hemodynamic stenosis severity as FFR or iFR. However, its diagnostic performance was inferior to FFR and iFR when PET-derived RFR and CFC were used as a reference.
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Affiliation(s)
- Neng Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinlong Zhang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yaliang Tong
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Ki Hyun Jeon
- Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bon Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.,Institute on Aging, Seoul National University, Seoul, Korea.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
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18
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Cho SG, Lee SJ, Na MH, Choi YY, Bom HHS. Comparison of diagnostic accuracy of PET-derived myocardial blood flow parameters: A meta-analysis. J Nucl Cardiol 2020; 27:1955-1966. [PMID: 30390243 DOI: 10.1007/s12350-018-01476-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although absolute quantification of myocardial blood flow (MBF) by positron emission tomography provides additive diagnostic value to visual analysis of perfusion defect, diagnostic accuracy of different MBF parameters remain unclear. METHODS Clinical studies regarding the diagnostic accuracy of hyperemic MBF (hMBF), myocardial flow reserve (MFR) and/or relative flow reserve (RFR) were searched and systematically reviewed. On a per-vessel basis, pooled measures of the parameters' diagnostic performances were analyzed, regarding significant coronary stenosis defined by fractional flow reserve or diameter stenosis. RESULTS Ten studies (2,522 arteries from 1,099 patients) were finally included. Pooled sensitivity [95% confidence interval (CI)] was 0.853 (0.821-0.881) for hMBF, 0.755 (0.713-0.794) for MFR, and 0.636 (0.539-0.726) for RFR. Pooled specificity (95% CI) was 0.844 (0.827-0.860) for hMBF, 0.804 (0.784-0.824) for MFR, and 0.897 (0.860-0.926) for RFR. Pooled area under the curve ± standard error was 0.900 ± 0.020 for hMBF, 0.830 ± 0.026 for MFR, and 0.873 ± 0.048 for RFR. CONCLUSIONS hMBF showed the best sensitivity while RFR showed the best specificity in the diagnosis of significant coronary stenosis. MFR was less sensitive than hMBF and less specific than hMBF and RFR.
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Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
| | - Soo Jin Lee
- Department of Nuclear Medicine, Hanyang University Medical Center, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Myung Hwan Na
- Department of Statistics, Chonnam National University, 45, Yongbong-ro, Buk-gu, Kwangju, 61186, Republic of Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea.
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19
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Jeon WK, Park J, Koo BK, Suh M, Yang S, Kim HY, Lee JM, Kim KJ, Choi JH, Lim HS, Paeng JC, Hwang D, Kim HS. Anatomical attributes of clinically relevant diagonal branches in patients with left anterior descending coronary artery bifurcation lesions. EUROINTERVENTION 2020; 16:e715-e723. [PMID: 31719001 DOI: 10.4244/eij-d-19-00534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to investigate the anatomical attributes determining myocardial territory of diagonal branches and to develop prediction models for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). METHODS AND RESULTS The amount of ischaemia and subtended myocardial mass of diagonal branches was quantified using MPI by percent ischaemic myocardium (%ischaemia) and CCTA by percent fractional myocardial mass (%FMM), respectively. In 49 patients with isolated diagonal branch disease, the mean %ischaemia by MPI was 6.8±4.0%, whereas in patients with total occlusion or severe disease of all diagonal branches it was 8.4±3.3%. %ischaemia was different according to the presence of non-diseased diagonal branches and dominant left circumflex artery (LCx). In the CCTA cohort (306 patients, 564 diagonal branches), mean %FMM was 5.9±4.4% and 86 branches (15.2%) had %FMM ≥10%. %FMM was different according to LCx dominance, number of branches, vessel size, and relative dominance between two diagonal branches. The diagnostic accuracy of prediction models for %FMM ≥10% based on logistic regression and decision tree was 0.92 (95% CI: 0.85-0.96) and 0.91 (95% CI: 0.84-0.96), respectively. There was no difference in the diagnostic performance of models with and without size criterion. CONCLUSIONS LCx dominance, number of branches, vessel size, and dominance among diagonal branches determined the myocardial territory of diagonal branches. Clinical application of prediction models based on these anatomical attributes can help to determine the clinically relevant diagonal branches in the cardiac catheterisation laboratory. CLINICAL TRIAL REGISTRATION NCT03935542
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Affiliation(s)
- Won Kyeong Jeon
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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20
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Piccinelli M, Cho SG, Garcia EV, Alexanderson E, Lee JM, Cooke CD, Goyal N, Sanchez MS, Folks RD, Chen Z, Votaw J, Koo BK, Bom HS. Vessel-specific quantification of absolute myocardial blood flow, myocardial flow reserve and relative flow reserve by means of fused dynamic 13NH 3 PET and CCTA: Ranges in a low-risk population and abnormality criteria. J Nucl Cardiol 2020; 27:1756-1769. [PMID: 30374847 PMCID: PMC6488439 DOI: 10.1007/s12350-018-01472-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/15/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The goal of the present work is to present a novel methodology for the extraction of MBF, MFR and RFR along coronary arteries by means of multimodality image fusion of dynamic PET and CCTA images. BACKGROUND FFR is the reference standard to identify flow-limiting lesions, but its invasiveness limits broad application. New noninvasive methodologies are warranted to stratify patients and guide treatment. METHODS A group of 16 low-risk CAD subjects who underwent both 13NH3 PET and CCTA were analyzed. Image fusion techniques were employed to align the studies and CCTA-derived anatomy used to identify coronaries trajectories. MBF was calculated by means of a 1-tissue compartmental model for the standard vascular territories and along patient-specific vessel paths from the base to the apex of the heart. RESULTS Low-risk ranges for MBF. MFR and RFR for LAD, LCX and rPDA were computed for the entire cohort and separated by gender. Computed low-risk ranges were used to assess a prospective patient with suspected CAD. CONCLUSIONS Our vessel-specific functional indexes and 3D displays offer promise to more closely replicate what is commonly performed during a catheterization session and have the potential of providing effective noninvasive tools for the identification of flow-limiting lesions and image-guided therapy.
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Affiliation(s)
- Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA.
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Erick Alexanderson
- Nuclear Cardiology Department, Instituto Nacional de Cardiologia, Mexico City, Mexico
| | - Joo Myung Lee
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Nikhil Goyal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | | | - Russel D Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Zhengjia Chen
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, USA
| | - John Votaw
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, NE, Atlanta, GA, 3032, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
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21
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Lee JM, Lee SH, Hwang D, Rhee TM, Choi KH, Kim J, Park J, Kim HY, Jung HW, Cho YK, Yoon HJ, Song YB, Hahn JY, Nam CW, Shin ES, Doh JH, Hur SH, Koo BK. Long-Term Clinical Outcomes of Nonhyperemic Pressure Ratios: Resting Full-Cycle Ratio, Diastolic Pressure Ratio, and Instantaneous Wave-Free Ratio. J Am Heart Assoc 2020; 9:e016818. [PMID: 32914672 PMCID: PMC7726993 DOI: 10.1161/jaha.120.016818] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Nonhyperemic pressure ratios (NHPRs) such as instantaneous wave‐free ratio, resting full‐cycle ratio, or diastolic pressure ratio have emerged as invasive physiologic indices precluding the need for hyperemic agents. The current study sought to evaluate the long‐term prognostic implications of NHPRs compared with fractional flow reserve (FFR). Methods and Results NHPRs were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The association between NHPRs and the risk of 5‐year vessel‐oriented composite outcomes (VOCO, a composite of cardiac death, vessel‐related myocardial infarction, and ischemia‐driven revascularization) were analyzed among 864 deferred vessels. Lesions with positive NHPRs (instantaneous wave free ratio, resting full‐cycle ratio, and diastolic pressure ratio ≤0.89) or FFR (≤0.80) showed significantly higher risk of VOCO at 5 years than those with negative NHPRs or FFR, respectively. Discriminant ability for 5‐year VOCO was not different among NHPRs and FFR (C‐index: 0.623–0.641, P for comparison=0.215). In comparison of VOCO among the groups with deferred concordant negative (NHPRs−/FFR−), deferred discordant (NHPRs+/FFR− or NHPRs−/FFR+), and revascularized vessels, the cumulative incidence of VOCO were 7.5%, 14.4%, and 14.8% (log‐rank P<0.001), respectively. The deferred discordant group showed similar risk of VOCO with the revascularized vessel group (hazard ratio, 0.981; 95% CI 0.434–2.217, P=0.964). Conclusions Currently available invasive pressure‐derived indices showed similar prognostic implications for vessel‐related events at 5 years. Deferred lesions with discordant results between NHPRs and FFR did not show higher risk of vessel‐related events at 5 years than revascularized vessels. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01621438, NCT01621438.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Seung Hun Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
| | - Ki Hong Choi
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Jinseob Kim
- Department of Epidemiology School of Public Health Seoul National University Seoul South Korea
| | - Jinhyoung Park
- Department of Biomedical Engineering Sungkyunkwan University Suwon Gyeonggi-do South Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine Chonnam National University Hospital Gwangju South Korea
| | - Hae Won Jung
- Department of Cardiology Daegu Catholic University Medical Center Daegu South Korea
| | - Yun-Kyeong Cho
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Hyuck-Jun Yoon
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Young Bin Song
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Joo-Yong Hahn
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Chang-Wook Nam
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Eun-Seok Shin
- Division of Cardiology Ulsan Medical Center Ulsan South Korea
| | - Joon-Hyung Doh
- Department of Medicine Inje University Ilsan Paik Hospital Goyang South Korea
| | - Seung-Ho Hur
- Department of Medicine Keimyung University Dongsan Medical Center Daegu South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea.,Institute on Aging Seoul National University Seoul South Korea
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22
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Diagnostic analysis of new quantitative parameters of low-dose dynamic myocardial perfusion imaging with CZT SPECT in the detection of suspected or known coronary artery disease. Int J Cardiovasc Imaging 2020; 37:367-378. [PMID: 32914404 PMCID: PMC7878253 DOI: 10.1007/s10554-020-01962-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
The goal of this study is to explore and evaluate the diagnostic values of myocardial blood flow (MBF), myocardial flow reserve (MFR) and relative flow reserve (RFR) obtained with low-dose dynamic CZT SPECT for patients with suspected or known coronary artery disease (CAD). Fifty-seven consecutive patients who underwent low-dose dynamic CZT SPECT and CAG were enrolled. MBF, MFR and RFR were calculated on the vessel level with dedicated quantitative software, and the difference and correlation of each parameter was compared according to the reference standard of stenosis ≥ 50% or ≥ 75% on CAG, respectively. ROC curves were made by stress MBF (sMBF), rest MBF (rMBF), MFR and RFR. The optimal cut-off values and corresponding diagnostic efficacy were obtained and compared with each other. Results indicated that when stenosis ≥ 50% or ≥ 75% on CAG was used as the reference standard at the vessel level, there was no statistically significant difference in rMBF between the negative group and the positive group (P > 0.05), and the sMBF and MFR in positive groups were significantly lower than that in the negative group (all P < 0.05). There was a moderate to significant correlation between sMBF and MFR, sMBF and RFR, MFR and RFR (all P < 0.0001). These results indicate that low-dose dynamic CZT SPECT imaging can easily obtain the sMBF, MFR and RFR, and there is a good correlation among the three parameters, which has a certain diagnostic value for patients with suspected or known CAD, and is a useful supplement to the conventional qualitative or semi-quantitative diagnostic methods.
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23
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Dilsizian V, Gewirtz H, Marwick TH, Kwong RY, Raggi P, Al-Mallah MH, Herzog CA. Cardiac Imaging for Coronary Heart Disease Risk Stratification in Chronic Kidney Disease. JACC Cardiovasc Imaging 2020; 14:669-682. [PMID: 32828780 DOI: 10.1016/j.jcmg.2020.05.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD), defined as dysfunction of the glomerular filtration apparatus, is an independent risk factor for the development of coronary artery disease (CAD). Patients with CKD are at a substantially higher risk of cardiovascular mortality compared with the age- and sex-adjusted general population with normal kidney function. The risk of CAD and mortality in patients with CKD is correlated with the degree of renal dysfunction including presence of microalbuminuria. A greater cardiovascular risk, albeit lower than for patients receiving dialysis, persists even after kidney transplantation. Congestive heart failure, commonly caused by CAD, also accounts for a significant portion of the cardiovascular-related events observed in CKD. The optimal strategy for the evaluation of CAD in patients with CKD, particularly before renal transplantation, remains a topic of contention spanning over several decades. Although the evaluation of coexisting cardiac disease in patients with CKD is desirable, severe renal dysfunction limits the use of radiographic and magnetic resonance contrast agents due to concerns regarding contrast-induced nephropathy and nephrogenic systemic sclerosis, respectively. In addition, many patients with CKD have extensive and premature (often medial) calcification disproportionate to the severity of obstructive CAD, thereby limiting the diagnostic value of computed tomography angiography. As such, echocardiography, non-contrast-enhanced magnetic resonance, nuclear myocardial perfusion, and metabolic imaging offer a variety of approaches to assess obstructive CAD and cardiomyopathy of advanced CKD without the need for nephrotoxic contrast agents.
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Affiliation(s)
- Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Henry Gewirtz
- Department of Medicine (Cardiology Division), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Charles A Herzog
- Department of Medicine (Cardiology Division) and Chronic Disease Research Group, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
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24
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Benz DC, Kaufmann PA, von Felten E, Benetos G, Rampidis G, Messerli M, Giannopoulos AA, Fuchs TA, Gräni C, Gebhard C, Pazhenkottil AP, Flammer AJ, Kaufmann PA, Buechel RR. Prognostic Value of Quantitative Metrics From Positron Emission Tomography in Ischemic Heart Failure. JACC Cardiovasc Imaging 2020; 14:454-464. [PMID: 32771569 DOI: 10.1016/j.jcmg.2020.05.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the prognostic and clinical value of quantitative positron emission tomographic (PET) metrics in patients with ischemic heart failure. BACKGROUND Although myocardial flow reserve (MFR) is a strong predictor of cardiac risk in patients without heart failure, it is unknown whether quantitative PET metrics improve risk stratification in patients with ischemic heart failure. METHODS The study included 254 patients referred for stress and rest myocardial perfusion imaging and viability testing using PET. Major adverse cardiac event(s) (MACE) consisted of death, resuscitated sudden cardiac death, heart transplantation, acute coronary syndrome, hospitalization for heart failure, and late revascularization. RESULTS MACE occurred in 170 patients (67%) during a median follow-up of 3.3 years. In a multivariate Cox proportional hazards model including multiple quantitative PET metrics, only MFR predicted MACE significantly (p = 0.013). Beyond age, symptom severity, diabetes mellitus, previous myocardial infarction or revascularization, 3-vessel disease, renal insufficiency, ejection fraction, as well as presence and burden of ischemia, scar, and hibernating myocardium, MFR was strongly associated with MACE (adjusted hazard ratio per increase in MFR by 1: 0.63; 95% confidence interval: 0.45 to 0.91). Incorporation of MFR into a risk assessment model incrementally improved the prediction of MACE (likelihood ratio chi-square test [16] = 48.61 vs. chi-square test [15] = 39.20; p = 0.002). CONCLUSIONS In this retrospective analysis of a single-center cohort, quantitative PET metrics of myocardial blood flow all improved risk stratification in patients with ischemic heart failure. However, in a hypothesis-generating analysis, MFR appears modestly superior to the other metrics as a prognostic index.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Philippe A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Georgios Benetos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Georgios Rampidis
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
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25
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AlBadri A, Piccinelli M, Cho SG, Lee JM, Jaber W, De Cecco CN, Samady H, Koo BK, Bom HS, Garcia EV. Rationale and design of the quantification of myocardial blood flow using dynamic PET/CTA-fused imagery (DEMYSTIFY) to determine physiological significance of specific coronary lesions. J Nucl Cardiol 2020; 27:1030-1039. [PMID: 32026327 PMCID: PMC7332386 DOI: 10.1007/s12350-020-02052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Coronary physiology assessments have been shown by multiple trials to add clinical value in detecting significant coronary artery disease and predicting cardiovascular outcomes. Fractional flow reserve (FFR) obtained during invasive coronary angiography (ICA) has become the new reference standard for hemodynamic significance detection. Absolute myocardial blood flow (MBF) quantification by means of dynamic positron emission tomography (dPET) has high diagnostic and prognostic values. FFR is an invasive measure and as such cannot be applied broadly, while MBF quantification is commonly performed on standard vascular territories intermixing normal flow from normal regions with abnormal flow from abnormal regions and consequently limiting its diagnostic power. OBJECTIVE The aim of this study is to provide physicians with reliable software tools for the non-invasive assessment of lesion-specific physiological significance for the entire coronary tree by combining PET-derived absolute flow data and coronary computed tomography angiography (CTA)-derived anatomy and coronary centerlines. METHODS The dynamic PET/CTA myocardial blood flow assessment with fused imagery (DEMYSTIFY) study is an observational prospective clinical study to develop algorithms and software tools to fuse coronary anatomy data obtained from CTA with dPET data to non-invasively measure absolute MBF, myocardial flow reserve, and relative flow reserve across specific coronary lesions. Patients (N = 108) will be collected from 4 institutions (Emory University Hospital, USA; Chonnam National University Hospital, South Korea; Samsung Medical Center, South Korea; Seoul National University Hospital, South Korea). These results will be compared to those obtained invasively in the catheterization laboratory and to a relatively novel non-invasive technique to estimate FFR based on CTA and computational fluid dynamics. CONCLUSIONS Success of these developments should lead to the following benefits: (1) eliminate unnecessary invasive coronary angiography in patients with no significant lesions, (2) avoid stenting physiologically insignificant lesions, (3) guide percutaneous coronary interventions process to the location of significant lesions, (4) provide a flow-color-coded 3D roadmap of the entire coronary tree to guide bypass surgery, and (5) use less radiation and lower the cost from unnecessary procedures. TRIAL REGISTRY The DEMYSTIFY study has been registered on ClinicalTrials.gov with registration number NCT04221594.
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Affiliation(s)
- Ahmed AlBadri
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Heart Vascular Stroke Institute, Seoul, Korea
| | - Wissam Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo N De Cecco
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Habib Samady
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University, Gwangju, Korea
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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26
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Cho SG, Kim HS, Cho JY, Kim JH, Bom HS. Diagnostic Value of Lesion-specific Measurement of Myocardial Blood Flow Using Hybrid PET/CT. J Cardiovasc Imaging 2020; 28:94-105. [PMID: 32052606 PMCID: PMC7114456 DOI: 10.4250/jcvi.2019.0087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 11/27/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We evaluated whether lesion-specific measurement of myocardial blood flow (MBF) and flow reserve (MFR) by hybrid imaging of myocardial perfusion positron emission tomography (PET) and coronary computed tomography (CT) can provide additional diagnostic value. METHODS Forty-three patients with stable angina underwent N-13 ammonia PET and coronary CT before invasive coronary angiography (CAG). The lesion-specific MBF was calculated from the average MBF of the myocardial segments downstream of a coronary stenosis using hybrid PET/CT images. The hyperemic MBF, resting MBF, and MFR were measured for the left anterior descending artery (LAD) using conventional and lesion-specific methods. The diagnostic accuracy was compared between the two methods for significant LAD stenoses (≥ 70% reference diameter on CAG). RESULTS There were 19 significant LAD stenoses. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were 71%, 68%, 74%, 65%, and 70% for conventional hyperemic MBF (optimal cutoff = 2.15 mL/min/g), 79%, 63%, 74%, 65%, and 70% for conventional MFR (optimal cutoff = 1.82), 83%, 74%, 80%, 78%, and 80% for lesion-specific hyperemic MBF (optimal cutoff = 1.75 mL/min/g), and 79%, 79%, 83%, 75%, and 79% for lesion-specific MFR (optimal cutoff = 1.86), respectively. The lesion-specific measurement was more accurate and had a better linear correlation with anatomical stenosis severity for both hyperemic MBF and MFR. CONCLUSIONS Lesion-specific measurement using hybrid PET/CT imaging showed significant improvement in the diagnostic accuracy of PET-measured hyperemic MBF and MFR.
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Affiliation(s)
- Sang Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyeon Sik Kim
- Medical Photonics Research Center, Korea Photonics Technology Institute, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hee Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeollanam-do, Korea.
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27
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Abstract
PURPOSE OF REVIEW This review discusses similarities and differences between cardiac positron emission tomography (PET), absolute myocardial blood flow, and flow reserve with invasive fractional flow reserve (FFR). RECENT FINDINGS Fundamentally, cardiac PET measures absolute myocardial blood flow whereas FFR provides a relative flow reserve. Cardiac PET offers a non-invasive and therefore lower risk alternative, able to image the entire left ventricle regardless of coronary anatomy. While cardiac PET can provide unique information about the subendocardium, FFR pullbacks offer unparalleled spatial resolution. Both diagnostic tests provide a highly repeatable and technically successful index of coronary hemodynamics that accounts for the amount of distal myocardial mass, albeit only indirectly with FFR. The randomized evidence base for FFR and its associated cost effectiveness remains unsurpassed. Cardiac PET and FFR have been intertwined since the very development of FFR over 25 years ago. Recent work has emphasized the ability of both techniques to guide revascularization decisions by high-quality physiology. In the past few years, cardiac PET has expanded its evidence base regarding clinical outcomes, whereas FFR has solidified its position in randomized studies as the invasive reference standard.
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Affiliation(s)
- Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
| | - K. Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
- Memorial Hermann Hospital, Houston, TX USA
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28
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Lee JM, Choi KH, Park J, Hwang D, Rhee TM, Kim J, Park J, Kim HY, Jung HW, Cho YK, Yoon HJ, Song YB, Hahn JY, Nam CW, Shin ES, Doh JH, Hur SH, Koo BK. Physiological and Clinical Assessment of Resting Physiological Indexes. Circulation 2019; 139:889-900. [PMID: 30586749 DOI: 10.1161/circulationaha.118.037021] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recently, resting pressure-derived indexes such as resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have been introduced to assess the functional significance of epicardial coronary stenosis. The present study sought to investigate the agreement of RFR or dPR with other pressure-derived indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve), the sensitivity of RFR or dPR for anatomic or hemodynamic stenosis severity, and the prognostic implications of RFR or dPR compared with iFR Methods: RFR and dPR were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The changes in resting physiological indexes according to diameter stenosis were compared among iFR, RFR, and dPR. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indexes according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between resting physiological indexes and the risk of 2-year vessel-oriented composite outcomes (a composite of cardiac death, vessel-related myocardial infarction, and vessel-related ischemia-driven revascularization) was analyzed among 864 deferred vessels. RESULTS Both RFR and dPR showed a significant correlation with iFR ( R=0.979, P<0.001 for RFR; and R=0.985, P<0.001 for dPR), which was higher than that with fractional flow reserve ( R=0.822, P<0.001; and R=0.819, P<0.001, respectively). RFR and dPR showed a very high agreement with iFR (C index, 0.987 and 0.993). Percent difference of iFR, RFR, and dPR according to the increase in anatomic and hemodynamic severity was almost identical. The diagnostic performance of iFR, RFR, and dPR was not different in the prediction of myocardial ischemia defined by both low hyperemic myocardial blood flow and low coronary flow reserve by 13N-ammonia positron emission tomography. All resting physiological indexes showed significant association with the risk of 2-year vessel-oriented composite outcomes (iFR per 0.1 increase: hazard ratio, 0.514 [95% CI, 0.370-0.715], P<0.001; RFR per 0.1 increase: hazard ratio, 0.524 [95% CI, 0.378-0.725], P<0.001; dPR per 0.1 increase: hazard ratio, 0.587 [95% CI, 0.436-0.791], P<0.001) in deferred vessels. CONCLUSIONS All resting pressure-derived physiological indexes (iFR, RFR, and dPR) can be used as invasive tools to guide treatment strategy in patients with coronary artery disease. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01621438.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.)
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.)
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.).,Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, South Korea (Jonghanne Park).,Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea (Jinhyoung Park)
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.)
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.)
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health (J.K.), Seoul National University, South Korea
| | | | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea (H.Y.K.)
| | - Hae Won Jung
- Department of Cardiology, Daegu Catholic University Medical Center, South Korea (H.W.J.)
| | - Yun-Kyeong Cho
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.)
| | - Hyuck-Jun Yoon
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.)
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.)
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.)
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.)
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, South Korea (E.-S.S.).,Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.)
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.)
| | - Seung-Ho Hur
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.)
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.).,Institute on Aging (B.-K.K.), Seoul National University, South Korea
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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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Pontone G, Rabbat MG, Rossi A. Understanding Coronary Physiology Through Dynamic CT Perfusion Imaging. JACC Cardiovasc Imaging 2019; 13:977-979. [PMID: 31542522 DOI: 10.1016/j.jcmg.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, Illinois; Edward Hines Jr. Veteran's Affairs Hospital, Hines, Illinois
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Diagnostic Imaging, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, Milan, Italy
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Lee JM, Rhee TM, Choi KH, Park J, Hwang D, Kim J, Park J, Kim HY, Jung HW, Cho YK, Yoon HJ, Song YB, Hahn JY, Nam CW, Shin ES, Doh JH, Hur SH, Koo BK. Clinical Outcome of Lesions With Discordant Results Among Different Invasive Physiologic Indices - Resting Distal Coronary to Aortic Pressure Ratio, Resting Full-Cycle Ratio, Diastolic Pressure Ratio, Instantaneous Wave-Free Ratio, and Fractional Flow Reserve. Circ J 2019; 83:2210-2221. [PMID: 31484836 DOI: 10.1253/circj.cj-19-0230] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND We evaluated the 2-year clinical outcomes of deferred lesions with discordant results between resting and hyperemic pressure-derived physiologic indices, including resting distal to aortic coronary pressure (resting Pd/Pa), instantaneous wave-free ratio (iFR), resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and fractional flow reserve (FFR).Methods and Results:The 2-year clinical outcomes of 1,024 vessels (435 patients) with available resting Pd/Pa, iFR, RFR, dPR, and FFR data were analyzed according to a 4-group classification using known cutoff values (resting Pd/Pa ≤0.92, iFR/RFR/dPR ≤0.89, and FFR ≤0.80): Group 1 (concordant normal), Group 2 (high resting index and low FFR), Group 3 (low resting index and high FFR), and Group 4 (concordance abnormal). The primary outcome was vessel-oriented composite outcomes (VOCO) in deferred vessels at 2 years. In the comparison of VOCO risk among 4 groups classified according to FFR and 4 resting physiologic indices, Group 4 consistently showed a significantly higher risk of VOCO than Group 1. Comparison of VOCO risk among 4 groups classified according to iFR and other resting physiologic indices also showed the same results. The presence of discordance, either between hyperemic and resting indices or among resting indices, was not an independent predictor for VOCO. CONCLUSIONS Discordant results between resting physiologic indices and FFR and among the resting indices were not associated with increased risk of VOCO in deferred lesions.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital.,Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University
| | - Jinhyoung Park
- Department of Biomedical Engineering, Sungkyunkwan University
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital
| | - Hae Won Jung
- Department of Cardiology, Daegu Catholic University Medical Center
| | - Yun-Kyeong Cho
- Department of Medicine, Keimyung University Dongsan Medical Center
| | - Hyuck-Jun Yoon
- Department of Medicine, Keimyung University Dongsan Medical Center
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital.,Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital
| | - Seung-Ho Hur
- Department of Medicine, Keimyung University Dongsan Medical Center
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital.,Institute on Aging, Seoul National University
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Gewirtz H, Iskandrian AE, Morgan C, Schelbert HR. Positron-Emission Tomography Quantitative Measurements of Myocardial Blood Flow. JACC Cardiovasc Imaging 2019; 12:1864-1867. [DOI: 10.1016/j.jcmg.2019.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022]
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Rasmussen LD, Winther S, Westra J, Isaksen C, Ejlersen JA, Brix L, Kirk J, Urbonaviciene G, Søndergaard HM, Hammid O, Schmidt SE, Knudsen LL, Madsen LH, Frost L, Petersen SE, Gormsen LC, Christiansen EH, Eftekhari A, Holm NR, Nyegaard M, Chiribiri A, Bøtker HE, Böttcher M. Danish study of Non-Invasive testing in Coronary Artery Disease 2 (Dan-NICAD 2): Study design for a controlled study of diagnostic accuracy. Am Heart J 2019; 215:114-128. [PMID: 31323454 DOI: 10.1016/j.ahj.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coronary computed tomography angiography (CTA) is the preferred primary diagnostic modality when examining patients with low to intermediate pre-test probability of coronary artery disease (CAD). Only 20-30% of these have potentially obstructive CAD. Because of the relatively poor positive predictive value of coronary CTA, unnecessary invasive coronary angiographies (ICAs) are conducted with the costs and risks associated with the procedure. Hence, an optimized diagnostic CAD algorithm may reduce the numbers of ICAs not followed by revascularization. The Dan-NICAD 2 study has 3 equivalent main aims: (1) To examine the diagnostic precision of a sound-based diagnostic algorithm, The CADScor®System (Acarix A/S, Denmark), in patients with a low to intermediate pre-test risk of CAD referred to a primary examination by coronary CTA. We hypothesize that the CADScor®System provides better stratification prior to coronary CTA than clinical risk stratification scores alone. (2) To compare the diagnostic accuracy of 3T cardiac magnetic resonance imaging (3T CMRI), 82rubidium positron emission tomography (82Rb-PET), and CT-derived fractional flow reserve (FFRCT) in patients where obstructive CAD cannot be ruled out by coronary CTA using ICA fractional flow reserve (FFR) as reference standard. (3) To compare the diagnostic performance of quantitative flow ratio (QFR) and ICA-FFR in patients with low to intermediate pre-test probability of CAD using 82Rb-PET as reference standard. METHODS Dan-NICAD 2 is a prospective, multicenter, cross-sectional study including approximately 2,000 patients with low to intermediate pre-test probability of CAD and without previous history of CAD. Patients are referred to coronary CTA because of symptoms suggestive of CAD, as evaluated by a cardiologist. Patient interviews, sound recordings, and blood samples are obtained in connection with the coronary CTA. If coronary CTA does not rule out obstructive CAD, patients will be examined by 3T CMRI 82Rb-PET, FFRCT, ICA, and FFR. Reference standard is ICA-FFR. Obstructive CAD is defined as an FFR ≤0.80 or as high-grade stenosis (>90% diameter stenosis) by visual assessment. Diagnostic performance will be evaluated as sensitivity, specificity, predictive values, likelihood ratios, calibration, and discrimination. Enrolment started January 2018 and is expected to be completed by June 2020. Patients are followed for 10 years after inclusion. DISCUSSION The results of the Dan-NICAD 2 study are expected to contribute to the improvement of diagnostic strategies for patients suspected of CAD in 3 different steps: risk stratification prior to coronary CTA, diagnostic strategy after coronary CTA, and invasive wireless QFR analysis as an alternative to ICA-FFR.
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Lee JM, Hwang D, Choi KH, Kim CH, Bang JI, Suh M, Paeng JC, Cheon GJ, Koo BK. Diagnostic Performance of Nonhyperemic Pressure Ratios Assessed by 13N-Ammonium Positron Emission Tomography. JACC Cardiovasc Interv 2019; 12:1517-1518. [DOI: 10.1016/j.jcin.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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Comparison of diagnostic accuracy of stress myocardial perfusion imaging for detecting hemodynamically significant coronary artery disease between cardiac magnetic resonance and nuclear medical imaging: A meta-analysis. Int J Cardiol 2019; 293:278-285. [PMID: 31303392 DOI: 10.1016/j.ijcard.2019.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to compare the diagnostic accuracy of stress myocardial perfusion imaging between cardiac magnetic resonance (CMR) and nuclear medical imaging, including single-photon emission computed tomography (SPECT) and positron emission tomography (PET), for the diagnosis of hemodynamically significant coronary artery disease (CAD) with fractional flow reserve (FFR) as the reference standard. METHODS AND RESULTS We searched PubMed and Embase for all published studies that evaluated the diagnostic accuracy of stress myocardial perfusion imaging modalities, including CMR, SPECT, and PET, to diagnose hemodynamically significant CAD with FFR as the reference standard. A total of 28 articles met the inclusion criteria and were included in the meta-analysis: 14 CMR, 13 SPECT, and 5 PET articles. The results demonstrated a pooled sensitivity of 0.88 (95% confidence interval [CI]: 0.80-0.93), 0.69 (95% CI: 0.56-0.79), and 0.83 (95% CI: 0.70-0.91), and a pooled specificity of 0.89 (95% CI: 0.85-0.93), 0.85 (95% CI, 0.80-0.89), and 0.89 (95% CI, 0.86-0.91) for CMR, SPECT, and PET, respectively. The area under the curve (AUC) of CMR, PET, and SPECT was 0.94 (95% CI, 0.92-0.96), 0.92 (95% CI, 0.89-0.94), and 0.87 (95% CI, 0.83-0.89), respectively. CONCLUSIONS CMR and PET both have high accuracy and SPECT has moderate accuracy to detect hemodynamically significant CAD with FFR as the reference standard. Furthermore, the diagnostic accuracy of CMR at 3.0 T is superior to 1.5 T.
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Value of Relative Myocardial Perfusion at MRI for Fractional Flow Reserve-Defined Ischemia: A Pilot Study. AJR Am J Roentgenol 2019; 212:1002-1009. [PMID: 30860888 DOI: 10.2214/ajr.18.20469] [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] [Indexed: 01/26/2023]
Abstract
OBJECTIVE. Correcting the perfusion in areas distal to coronary stenosis (risk) according to that of normal (remote) areas defines the relative myocardial perfusion index, which is similar to the fractional flow reserve (FFR) concept. The aim of this study was to assess the value of relative myocardial perfusion by MRI in predicting lesion-specific inducible ischemia as defined by FFR. MATERIALS AND METHODS. Forty-six patients (33 men and 13 women; mean [± SD] age, 61 ± 9 years) who underwent adenosine perfusion MRI and FFR measurement distal to 49 coronary artery stenoses during coronary angiography were retrospectively evaluated. Subendocardial time-enhancement maximal upslopes, normalized by the respective left ventricle cavity upslopes, were obtained in risk and remote subendocardium during adenosine and rest MRI perfusion and were correlated to the FFR values. RESULTS. The mean FFR value was 0.84 ± 0.09 (range, 0.60-0.98) and was less than or equal to 0.80 in 31% of stenoses (n = 15). The relative subendocardial perfusion index (risk-to-remote upslopes) during hyperemia showed better correlations with the FFR value (r = 0.59) than the uncorrected risk perfusion parameters (i.e., both the upslope during hyperemia and the perfusion reserve index [stress-to-rest upslopes]; r = 0.27 and 0.29, respectively). A cutoff value of 0.84 of the relative subendocardial perfusion index had an ROC AUC of 0.88 to predict stenosis at an FFR of less than or equal to 0.80. CONCLUSION. Using adenosine perfusion MRI, the relative myocardial perfusion index enabled the best prediction of FFR-defined lesion-specific myocardial ischemia. This index could be used to noninvasively determine the need for revascularization of known coronary stenoses.
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37
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Cho SG, Jabin Z, Lee C, Bom HHS. The tools are ready, are we? J Nucl Cardiol 2019; 26:557-560. [PMID: 28828735 DOI: 10.1007/s12350-017-1032-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Zeenat Jabin
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
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38
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Benz DC, Gräni C, Ferro P, Neumeier L, Messerli M, Possner M, Clerc OF, Gebhard C, Gaemperli O, Pazhenkottil AP, Kaufmann PA, Buechel RR. Corrected coronary opacification decrease from coronary computed tomography angiography: Validation with quantitative 13N-ammonia positron emission tomography. J Nucl Cardiol 2019; 26:561-568. [PMID: 28685251 DOI: 10.1007/s12350-017-0980-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To assess the functional relevance of a coronary artery stenosis, corrected coronary opacification (CCO) decrease derived from coronary computed tomography angiography (CCTA) has been proposed. The present study aims at validating CCO decrease with quantitative 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI). METHODS AND RESULTS This retrospective study consists of 39 patients who underwent hybrid CCTA/PET-MPI. From CCTA, attenuation in the coronary lumen was measured before and after a stenosis and corrected to the aorta to calculate CCO and its decrease. Relative flow reserve (RFR) was calculated by dividing the stress myocardial blood flow (MBF) of a vessel territory subtended by a stenotic coronary by the stress MBF of the reference territories without stenoses. RFR was abnormal in 11 vessel territories (27%). CCO decrease yielded a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for prediction of an abnormal RFR of 73%, 70%, 88%, 47%, and 70%, respectively. CONCLUSIONS CCTA-derived CCO decrease has moderate diagnostic accuracy to predict an abnormal RFR in PET-MPI. However, its high negative predictive value to rule out functional relevance of a given lesion may confer clinical implications in the diagnostic work-up of patients with a coronary stenosis.
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Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Paola Ferro
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Luis Neumeier
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Mathias Possner
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Olivier F Clerc
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Gewirtz H. Coronary circulation: Pressure/flow parameters for assessment of ischemic heart disease. J Nucl Cardiol 2019; 26:459-470. [PMID: 29637523 DOI: 10.1007/s12350-018-1270-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
Both invasive and non-invasive parameters have been reported for assessment of the physiological status of the coronary circulation. Fractional flow reserve and coronary (or myocardial) flow reserve may be obtained by invasive or non-invasive means. These metrics of coronary stenosis severity have achieved wide clinical acceptance for guiding revascularization decisions and risk stratification. Other indices are obtained invasively (e.g., instantaneous wave-free ratio, iFR; hyperemic stenosis resistance) or non-invasively (e.g., PET absolute myocardial blood flow (mL/min/g)) and have been used for the same purposes. Both iFR, and whole-cycle distal coronary to aortic mean pressure (Pd/Pa) are measured under basal condition and used for assessment of hemodynamic stenosis severity as is index of basal stenosis resistance (BSR). These metrics typically are dichotomized at an empirically derived cut point into "normal" and "abnormal" categories for purposes of clinical decision making and data analysis. Once dichotomized the indices do not always point in the same direction and so confusion may arise. This review, therefore, will present basic principles relevant to understanding commonly employed metrics of the physiological status of the coronary circulation, potential strengths and weaknesses, and hopefully an improved appreciation of the clinical information provided by each.
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Affiliation(s)
- Henry Gewirtz
- Department of Medicine (Cardiology Division), Harvard Medical School, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on quantification of myocardial blood flow (MBF) with positron emission tomography (PET) imaging. Technical and clinical aspects of flow quantification with PET are reviewed. RECENT FINDINGS The diagnostic and prognostic values of myocardial flow quantification have been established in numerous studies and in various populations. MBF quantification has also shown itself to be particularly useful in the assessment of coronary microvascular dysfunction and in evaluation of cardiac allograft vasculopathy. Overall, myocardial flow reserve (MFR) and hyperemic MBF can lead to improved risk stratification by providing information complementary to that of other markers of disease severity, such as fractional flow reserve. Flow quantification enhances MPI's ability to detect both significant epicardial disease and microvascular dysfunction. With recent technological and methodological advances, flow quantification with PET is no longer restricted to cyclotron-equipped academic centers.
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Affiliation(s)
- Matthieu Pelletier-Galarneau
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Medical Imaging, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Patrick Martineau
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Ghekiere O, Bielen J, Leipsic J, Dewilde W, Mancini I, Hansen D, Dendale P, Nchimi A. Correlation of FFR-derived from CT and stress perfusion CMR with invasive FFR in intermediate-grade coronary artery stenosis. Int J Cardiovasc Imaging 2018; 35:559-568. [PMID: 30284138 DOI: 10.1007/s10554-018-1464-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/26/2018] [Indexed: 01/15/2023]
Abstract
Only one-third of intermediate-grade coronary artery stenosis (i.e. 40-70% diameter narrowing) causes myocardial ischemia, requiring most often additional invasive work-up with invasive fractional flow reserve (FFR). To evaluate the correlations between FFR estimates derived from computed tomography (FFRCT) and adenosine perfusion cardiac magnetic resonance (CMR) with invasive FFR in intermediate-grade stenosis. Thirty-seven patients (mean age 61 ± 9 years; 25 men) who underwent adenosine perfusion CMR, quantitative coronary angiography and FFR in the work-up for intermediate-grade stenoses (n = 39) diagnosed at coronary CT angiography were retrospectively evaluated. Blinded FFRCT analysis was computed on each intermediate-grade lesion and correlated to the FFR values. On adenosine CMR, subendocardial time-enhancement maximal upslopes, normalized by respective left ventricle cavity upslopes, were obtained distal to a coronary stenosis (RISK area) and in remote myocardium (REMOTE area). The perfusion was subsequently assessed without (uncorrected RISK) and after correction for remote perfusion (relative myocardial perfusion index = REMOTE/RISK ratio), and then correlated to the FFR values. Differences in correlations were tested with z statistics and considered statistically significant different at a p < 0.05 level. The average FFR value was 0.85 ± 0.10 (0.60-0.98 range), 28% (n = 11) was ≤ 0.80. FFR value correlated poorly with uncorrected RISK upslopes (r = 0.151; p = 0.36), but equally strongly with FFRCT (r = 0.675; p < 0.001) and the relative myocardial perfusion index (r = - 0.63) (p < 0.001; z = 6.72) for assessment of lesion-specific ischemia. Both FFRCT and adenosine perfusion CMR strongly correlate with invasive FFR measurements for intermediate-grade stenosis. These preliminary findings pave the way for further studies evaluating non-invasively intermediate coronary stenosis in clinical practice.
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Affiliation(s)
- Olivier Ghekiere
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, 4000, Liège, Belgium. .,Department of Radiology, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium. .,Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, 3500, Hasselt, Belgium.
| | - Jurgen Bielen
- Department of Radiology, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC, BCV6Z 1Y6, Canada
| | - Willem Dewilde
- Department of Cardiology, Imelda Hospital, Imeldalaan 9, 2820, Bonheiden, Belgium
| | - Isabelle Mancini
- Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye, 75, 4000, Liège, Belgium
| | - Dominic Hansen
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, 3500, Hasselt, Belgium
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Biomed and Reval, Hasselt University, Agoralaan, Building A and C, 3500, Hasselt, Belgium.,Heart Center Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Alain Nchimi
- Centre Hospitalier de Luxembourg, 4, Rue Ernest Barble L-1120, LU 1210, Luxembourg City, Luxembourg
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42
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Bom MJ, Driessen RS, Raijmakers PG, Everaars H, Lammertsma AA, van Rossum AC, van Royen N, Knuuti J, Mäki M, Danad I, Knaapen P. Diagnostic value of longitudinal flow gradient for the presence of haemodynamically significant coronary artery disease. Eur Heart J Cardiovasc Imaging 2018; 20:21-30. [DOI: 10.1093/ehjci/jey129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/21/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michiel J Bom
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Roel S Driessen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Pieter G Raijmakers
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Maija Mäki
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Ibrahim Danad
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
| | - Paul Knaapen
- Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands
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43
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Low FFR equal to low ischemia: Really? Int J Cardiol 2018; 265:81. [PMID: 29885704 DOI: 10.1016/j.ijcard.2017.12.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/23/2017] [Indexed: 11/23/2022]
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44
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Vassilev D, Dosev L, Collet C, Karamfiloff K, Stoikova J, Pancheva R, Shumkova M, Zlatancheva G, Naunov V, Rigatelli G, Kassab GS, Gil RJ, Serruys PW. Intracoronary electrocardiogram to guide percutaneous interventions in coronary bifurcations - a proof of concept: the FIESTA (Ffr vs. IcEcgSTA) study. EUROINTERVENTION 2018; 14:e530-e537. [PMID: 28829743 DOI: 10.4244/eij-d-17-00189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to determine the accuracy of the intracoronary electrocardiogram (icECG) to detect ischaemia during bifurcation lesion percutaneous coronary intervention (PCI) with fractional flow reserve (FFR) as a reference. METHODS AND RESULTS Patients with significant bifurcation lesions defined as FFR ≤0.80 were included. FFR and icECG were performed in the main vessel (MV) and side branch (SB) before and after provisional stenting. icECG was recorded with an uninsulated proximal wire end connected to a unipolar lead. The diagnostic accuracy of the icECG for the detection of ischaemia in the SB after MV stenting was determined with FFR as a reference. Overall, 37 patients were included. Seventeen bifurcations had an SB FFR ≤0.80 after MV stenting and 20 patients had an ST-segment elevation on the icECG. There was significant correlation between SB FFR and ST-segment elevation on the icECG (r=-0.533, p<0.001). The diagnostic accuracy of icECG ST-elevation to detect functionally significant SB stenosis revealed an AUC of 0.71 (95% CI: 0.64-0.80) with a sensitivity of 88% and specificity of 75% with a positive predictive value of 75% and negative predictive value of 88%. Neither SB FFR nor icECG correlated with SB percent diameter stenosis after MV stenting. CONCLUSIONS Intracoronary ECG has a good ability to predict functionally significant stenosis at the SB after MV stenting during bifurcation PCI. This method provides a novel strategy to assess the significance of an SB lesion without the need of a pressure wire.
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Affiliation(s)
- Dobrin Vassilev
- "Alexandrovska" University Hospital, Cardiology Department, Medical University, Sofia, Bulgaria
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45
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Kim DY, Cho SG, Bom HS. Emerging Tracers for Nuclear Cardiac PET Imaging. Nucl Med Mol Imaging 2018; 52:266-278. [PMID: 30100939 PMCID: PMC6066491 DOI: 10.1007/s13139-018-0521-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/05/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022] Open
Abstract
Myocardial perfusion imaging using positron emission tomography (PET) has several advantages over single photon emission computed tomography (SPECT). The recent advances in SPECT technology have shown promise, but there is still a large need for PET in the clinical management of coronary artery disease (CAD). Especially, absolute quantification of myocardial blood flow (MBF) using PET is extremely important. In spite of considerable advances in the diagnosis of CAD, novel PET radiopharmaceuticals remain necessary for the diagnosis of CAD because clinical use of current cardiac radiotracers is limited by their physical characteristics, such as decay mode, emission energy, and half-life. Thus, the use of a radioisotope that has proper characteristics and a proper half-life to develop myocardial perfusion agents could overcome these limitations. In this review, the current state of cardiac PET and a general overview of novel 18F or 68Ga-labeled radiotracers, including their radiosynthesis, in vivo characterization, and evaluation, are provided. The future perspectives are discussed in terms of their potential usefulness based on new image analysis methods and hybrid imaging.
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Affiliation(s)
- Dong-Yeon Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeollanam-do 58128 Republic of Korea
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46
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15-O-water myocardial flow reserve PET and CT angiography by full hybrid PET/CT as a potential alternative to invasive angiography. Int J Cardiovasc Imaging 2018; 34:2011-2022. [PMID: 30066164 DOI: 10.1007/s10554-018-1420-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/23/2018] [Indexed: 01/14/2023]
Abstract
Combined myocardial flow reserve (MFR) by PET and CT coronary angiography (CTA) is a promising tool for assessment of coronary artery disease. Prior analyses of MFR/CTA has been performed as side-by-side interpretation, not as volume rendered, full hybrid analysis, with fused MFR/CTA. We aimed to: (i) establish a method for full hybrid analysis of MFR/CTA, (ii) validate the inter- and intra-observer reproducibility of MFR values, and (iii) determine the diagnostic value of side-by-side versus full hybrid MFR/CTA with 15-O-water PET. Forty-four outpatients scheduled for invasive coronary angiography (ICA) were enrolled prospectively. All underwent rest/stress 15-O-water PET/CTA with ICA as reference. Within two observers of different experience, the Pearson r at global and territorial level exceeded 0.953 for rest, stress, and MFR values, as determined by Carimas software. Within and between observers, the mean differences between rest, stress, and MFR values were close to zero and the confidence intervals for 95% limits of agreement were narrow. The diagnostic performance of full hybrid PET/CTA did not outperform the side-by-side approach, but performed better than MFR without CTA at vessel level: specificity 93% (95% confidence limits: 89-97%) versus 76% (64-88%), p = 0.0004; positive predictive value 71% (55-86%) versus 51% (37-65%), p = 0.0001; accuracy 90% (84-95%) versus 77% (69-84%), p = 0.0009. MFR showed high reproducibility within and between observers of different experience. The full hybrid model was not superior to side-by-side interpretation of MFR/CTA, but proved better than MFR alone at vessel level with regard to specificity, positive predictive value, and accuracy.
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47
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Feasibility of dynamic stress 201Tl/rest 99mTc-tetrofosmin single photon emission computed tomography for quantification of myocardial perfusion reserve in patients with stable coronary artery disease. Eur J Nucl Med Mol Imaging 2018; 45:2173-2180. [DOI: 10.1007/s00259-018-4057-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
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48
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Paeng JC, Lee DS. Screening high-risk patients and selecting treatment options in stable coronary artery disease using myocardial perfusion imaging. J Nucl Cardiol 2018; 25:967-969. [PMID: 28050859 DOI: 10.1007/s12350-016-0772-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea.
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49
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Driessen RS, Danad I, Stuijfzand WJ, Schumacher SP, Knuuti J, Mäki M, Lammertsma AA, van Rossum AC, van Royen N, Raijmakers PG, Knaapen P. Impact of Revascularization on Absolute Myocardial Blood Flow as Assessed by Serial [
15
O]H
2
O Positron Emission Tomography Imaging. Circ Cardiovasc Imaging 2018; 11:e007417. [DOI: 10.1161/circimaging.117.007417] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/27/2018] [Indexed: 01/07/2023]
Abstract
Background:
The main goal of coronary revascularization is to restore myocardial perfusion in case of ischemia, causing coronary artery disease. Yet, little is known on the effect of revascularization on absolute myocardial blood flow (MBF). Therefore, the present prospective study assesses the impact of coronary revascularization on absolute MBF as measured by [
15
O]H
2
O positron emission tomography and fractional flow reserve (FFR) in patients with stable coronary artery disease.
Methods and Results:
Fifty-three patients (87% men, mean age 58.7±9.0 years) with suspected coronary artery disease were included prospectively. All patients underwent serial [
15
O]H
2
O positron emission tomography perfusion imaging at baseline and after revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. FFR was routinely measured at baseline and directly post-PCI. After revascularization, regional rest and stress MBF improved from 0.77±0.16 to 0.86±0.25 mL/min/g and from 1.57±0.59 to 2.48±0.91 mL/min/g, respectively, yielding an increase in coronary flow reserve from 2.02±0.69 to 2.94±0.94 (
P
<0.01 for all). Mean FFR at baseline improved post-PCI from 0.61±0.17 to 0.89±0.08 (
P
<0.01). After PCI, an increase in FFR paralleled improvement in absolute myocardial perfusion as reflected by stress MBF and coronary flow reserve (
r
= 0.74 and
r
= 0.71, respectively,
P
<0.01 for both). PCI demonstrated a greater improvement of regional stress MBF as compared with coronary artery bypass graft surgery (1.14±1.11 versus 0.66±0.69 mL/min/g, respectively,
P
=0.02). However, patients undergoing bypass grafting had a more advanced stage of coronary artery disease and more incomplete revascularizations.
Conclusion:
Successful coronary revascularization has a significant and positive impact on absolute myocardial perfusion as assessed by serial quantitative [
15
O]H
2
O positron emission tomography. Notably, improvement of FFR after PCI was directly related to the increase in hyperemic MBF.
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Affiliation(s)
- Roel S. Driessen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | - Ibrahim Danad
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | | | | | - Juhani Knuuti
- VU University Medical Center, Amsterdam, The Netherlands. Turku PET Centre, Turku University Hospital and University of Turku, Finland (J.K., M.M.)
| | - Maija Mäki
- VU University Medical Center, Amsterdam, The Netherlands. Turku PET Centre, Turku University Hospital and University of Turku, Finland (J.K., M.M.)
| | | | | | - Niels van Royen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
| | | | - Paul Knaapen
- Department of Cardiology (R.S.D., I.D., W.J.S., S.P.S., A.C.v.R., N.v.R., P.K.)
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50
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Iskandrian AE, Dilsizian V, Garcia EV, Beanlands RS, Cerqueira M, Soman P, Berman DS, Cuocolo A, Einstein AJ, Morgan CJ, Hage FG, Schelbert HR, Bax JJ, Wu JC, Shaw LJ, Sadeghi MM, Tamaki N, Kaufmann PA, Gropler R, Dorbala S, Van Decker W. Myocardial perfusion imaging: Lessons learned and work to be done-update. J Nucl Cardiol 2018; 25:39-52. [PMID: 29110288 DOI: 10.1007/s12350-017-1093-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
As the second term of our commitment to Journal begins, we, the editors, would like to reflect on a few topics that have relevance today. These include prognostication and paradigm shifts; Serial testing: How to handle data? Is the change in perfusion predictive of outcome and which one? Ischemia-guided therapy: fractional flow reserve vs perfusion vs myocardial blood flow; positron emission tomography (PET) imaging using Rubidium-82 vs N-13 ammonia vs F-18 Flurpiridaz; How to differentiate microvascular disease from 3-vessel disease by PET? The imaging scene outside the United States, what are the differences and similarities? Radiation exposure; Special issues with the new cameras? Is attenuation correction needed? Are there normal databases and are these specific to each camera system? And finally, hybrid imaging with single-photon emission tomography or PET combined with computed tomography angiography or coronary calcium score. We hope these topics are of interest to our readers.
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Affiliation(s)
- Ami E Iskandrian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 318 LHRB/ 1900 University BLVD, Birmingham, AL, 35294, USA.
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Baltimore, 21201, USA
| | | | | | - Manuel Cerqueira
- Cleveland Clinic, Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Prem Soman
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel S Berman
- Cedars-Sinai Medical Center, University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Fadi G Hage
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | | | - Jeroen J Bax
- Leiden University Medical Center, Leiden, The Netherlands
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