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Kitkungvan D, Johnson NP, Roby AE, Mendoza P, Bui L, Patel MB, Sander K, Harmon L, Kirkeeide R, Gould KL. Quantitative Myocardial Perfusion in Liver Transplantation Candidates: Poorly metabolized caffeine inhibition of vasodilatory stress. J Nucl Cardiol 2024:101884. [PMID: 38761831 DOI: 10.1016/j.nuclcard.2024.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Data on cardiac positron emission tomography (PET) in liver transplantation (LT) candidates are limited with no prior study accounting for poorly metabolized caffeine reducing stress perfusion. METHOD Consecutive LT candidates (n=114) undergoing cardiac rest/stress PET were instructed to abstain from caffeine for 2 days extended to 5 and 7 days. Due to persistently high prevalence of measurable blood caffeine after 5-day caffeine abstinence, dipyridamole (n=41) initially used was changed to dobutamine (n=73). Associations of absolute flow, coronary flow reserve (CFR), detectable blood caffeine, and Modified End-Stage Liver Disease (MELD) score for liver failure severity were evaluated. Coronary flow data of LT candidates were compared to non-LT control group (n=102 for dipyridamole, n=29 for dobutamine) RESULTS: Prevalence of patients with detectable blood caffeine was 63.3%, 36.7% and 33.3% after 2-, 5- and 7-day of caffeine abstinence, respectively. MELD score was associated with detectable caffeine (odd ratio 1.18,p<0.001). CFR was higher during dipyridamole stress without-caffeine vs. with-caffeine (2.22±0.80 vs. 1.55±0.37,p=0.048) but lower than dobutamine stress (2.22±0.80 vs. 2.82±1.02,p=0.026). Mediation analysis suggested that the dominant association between CFR and MELD score in dipyridamole group derived from caffeine-impaired CFR and liver failure/caffeine interaction. CFR in LT candidates was lower than non-LT control population in both dipyridamole and dobutamine group. CONCLUSIONS We demonstrate exceptionally high prevalence of detectable blood caffeine in LT candidates undergoing stress PET myocardial perfusion imaging resulting in reduced CFR with dipyridamole compared to dobutamine. The delayed caffeine clearance in LT candidates makes dobutamine a preferred stress agent in this population.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Nils P Johnson
- Weatherhead Distinguished Chair of Heart Disease, Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Amanda E Roby
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston.
| | - Patricia Mendoza
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston.
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Monica B Patel
- Weatherhead PET Center, Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Kelly Sander
- Weatherhead PET Center, Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Lindsey Harmon
- Weatherhead PET Center, Division of Cardiology, McGovern Medical School, University of Texas, Houston.
| | - Richard Kirkeeide
- Weatherhead PET Center, McGovern Medical School, University of Texas, Houston.
| | - K Lance Gould
- Martin Bucksbaum Distinguished University Chair, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas, Houston.
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Johnson NP, Gould KL, Narula J. Should We Stent Vulnerable, But Asymptomatic, Lesions? JACC Cardiovasc Interv 2024; 17:471-473. [PMID: 38340101 DOI: 10.1016/j.jcin.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Nils P Johnson
- Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA.
| | - K Lance Gould
- Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis, Houston, Texas, USA; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Jagat Narula
- Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth, Houston, Texas, USA
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Gould KL, Johnson NP, Roby AE, Bui L, Kitkungvan D, Patel MB, Nguyen T, Kirkeeide R, Haynie M, Arain SA, Charitakis K, Dhoble A, Smalling R, Nascimbene A, Jumean M, Kumar S, Kar B, Sdringola S, Estrera A, Gregoric I, Lai D, Li R, McPherson D, Narula J. Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications. Eur Heart J 2024; 45:181-194. [PMID: 37634192 PMCID: PMC10787661 DOI: 10.1093/eurheartj/ehad579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization. METHODS Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0. RESULTS Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P < .001), more so after bypass surgery than percutaneous coronary interventions (P < .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P < .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025). CONCLUSIONS Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.
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Affiliation(s)
- K Lance Gould
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Nils P Johnson
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Amanda E Roby
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Linh Bui
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Danai Kitkungvan
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Monica B Patel
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Tung Nguyen
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Kirkeeide
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Mary Haynie
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Salman A Arain
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Konstantinos Charitakis
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Abhijeet Dhoble
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Richard Smalling
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Marwan Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Stefano Sdringola
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Anthony Estrera
- Department of Cardiothoracic Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Memorial Hermann Hospital, Houston, TX, USA
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, Houston, TX, USA
| | - Dejian Lai
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - Ruosha Li
- Department of Biostatistics and Data Science, University of Texas School of Public Health-Houston, Houston, TX, USA
| | - David McPherson
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
| | - Jagat Narula
- Department of Medicine, Division of Cardiology, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030, USA
- Department of Medicine, Division of Cardiology, McGovern Medical School, University of Texas Health Science Center, and Memorial Hermann Hospital, 6431 Fannin St, Rm 4.256 MSB, Houston, TX 77005, USA
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Gould KL. Evolving Cardiac Rehabilitation, Technology, and Coronary Pathophysiology. Am J Cardiol 2024; 210:286-287. [PMID: 37898158 DOI: 10.1016/j.amjcard.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Affiliation(s)
- K Lance Gould
- Division of Cardiology, Weatherhead PET Imaging Center, McGovern Medical School, University of Texas Health Science Center-Houston, Houston, Texas; Nuclear Cardiology, Memorial Hermann Hospital, Houston, Texas.
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Kitkungvan D, Johnson NP, Bui L, Patel MB, Roby AE, Haynie M, Kirkeeide R, Hood S, Gould KL. Does financial hardship associate with abnormal quantitative myocardial perfusion and major adverse cardiovascular event? J Nucl Cardiol 2023; 30:1528-1539. [PMID: 36639611 DOI: 10.1007/s12350-022-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Data on impact of financial hardship on coronary artery disease (CAD) remain incomplete. METHODS Consecutive subjects referred for clinical rest/stress cardiac positron emission tomography (PET) were enrolled. Financial hardship is defined as patients' inability to pay for their out-of-pocket expense for cardiac PET. Abnormal cardiac PET is defined as at least moderate relative perfusion defects at stress involving > 10% of the left ventricle or global coronary flow reserve ≤ 2.0. Patients were followed for major adverse cardiovascular event (MACE) comprised of all-cause mortality, non-fatal myocardial infarction, and late coronary revascularization. RESULTS We analyzed a total of 4173 patients with mean age 65.6 ± 11.3 years, 72.2% men, and 93.6% reported as having medical insurance. Of these, 504 (12.1%) patients had financial hardship. On multivariable analysis, financial hardship associated with abnormal cardiac PET (odds ratio 1.377, p = 0.004) and MACE (hazard ratio 1.432, p = 0.010) and its association with MACE was mostly through direct effect with small proportion mediated by abnormal cardiac PET or known CAD. CONCLUSION Among patients referred for cardiac rest/stress PET, financial hardship independently associates with myocardial perfusion abnormalities and MACE; however, its effect on MACE is largely not mediated by abnormal myocardial perfusion or known CAD suggesting distinct impact of financial hardship beyond traditional risk factors and CAD that deserves attention and intervention to effectively reduced adverse outcomes. Having medical insurance does not consistently protect from financial hardship and a more preventive-oriented restructuring may provide better outcomes at lower cost.
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Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nils P Johnson
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Monica B Patel
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amanda E Roby
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mary Haynie
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Richard Kirkeeide
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Susan Hood
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Lance Gould
- Division of Cardiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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Gould KL, Johnson NP, Narula J. Reply: Is Bolus-Thermodilution Reliable in Defining Coronary Microvascular Dysfunction? JACC Cardiovasc Imaging 2023; 16:994-995. [PMID: 37407128 DOI: 10.1016/j.jcmg.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023]
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Gould KL, Johnson NP, Narula J. Microvascular Dysfunction or Diffuse Epicardial CAD With Normal Stress Vasodilation. JACC Cardiovasc Imaging 2023; 16:549-552. [PMID: 37019600 DOI: 10.1016/j.jcmg.2022.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 04/07/2023]
Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas; Memorial Hermann Hospital, Houston, Texas, USA.
| | - Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas; Memorial Hermann Hospital, Houston, Texas, USA
| | - Jagat Narula
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas; Memorial Hermann Hospital, Houston, Texas, USA
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Gould KL, Nguyen T, Kirkeeide R, Roby AE, Bui L, Kitkungvan D, Patel MB, Madjid M, Haynie M, Lai D, Li R, Narula J, Johnson NP. Subendocardial and Transmural Myocardial Ischemia: Clinical Characteristics, Prevalence, and Outcomes With and Without Revascularization. JACC Cardiovasc Imaging 2023; 16:78-94. [PMID: 36599572 DOI: 10.1016/j.jcmg.2022.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Subendocardial ischemia is commonly diagnosed but not quantified by imaging. OBJECTIVES This study sought to define size and severity of subendocardial and transmural stress perfusion deficits, clinical associations, and outcomes. METHODS Regional rest-stress perfusion in mL/min/g, coronary flow reserve, coronary flow capacity (CFC), relative stress flow, subendocardial stress-to-rest ratio and stress subendocardial-to-subepicardial ratio as percentage of left ventricle were measured by positron emission tomography (PET) with rubidium Rb 82 and dipyridamole stress in serial 6,331 diagnostic PETs with prospective 10-year follow-up for major adverse cardiac events with and without revascularization. RESULTS Of 6,331 diagnostic PETs, 1,316 (20.7%) had severely reduced CFC with 41.4% having angina or ST-segment depression (STΔ) >1 mm during hyperemic stress, increasing with size. For 5,015 PETs with no severe CFC abnormality, 402 (8%) had angina or STΔ during stress, and 82% had abnormal subendocardial perfusion with 8.7% having angina or STΔ >1 mm during dipyridamole stress. Of 947 cases with stress-induced angina or STΔ >1 mm, 945 (99.8%) had reduced transmural or subendocardial perfusion reflecting sufficient microvascular function to increase coronary blood flow and reduce intracoronary pressure, causing reduced subendocardial perfusion; only 2 (0.2%) had normal subendocardial perfusion, suggesting microvascular disease as the cause of the angina. Over 10-year follow-up (mean 5 years), severely reduced CFC associated with major adverse cardiac events of 44.4% compared to 8.8% for no severe CFC (unadjusted P < 0.00001) and mortality of 15.2% without and 6.9% with revascularization (P < 0.00002) confirmed by multivariable Cox regression modeling. For no severe CFC, mortality was 3% with and without revascularization (P = 0.90). CONCLUSIONS Reduced subendocardial perfusion on dipyridamole PET without regional stress perfusion defects is common without angina, has low risk of major adverse cardiac events, reflecting asymptomatic nonobstructive diffuse coronary artery disease, or angina without stenosis. Severely reduced CFC causes angina in fewer than one-half of cases but incurs high mortality risk that is significantly reduced after revascularization.
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Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA.
| | - Tung Nguyen
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Richard Kirkeeide
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Amanda E Roby
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Linh Bui
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Danai Kitkungvan
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Monica B Patel
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Mohammad Madjid
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Mary Haynie
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
| | - Dejian Lai
- University of Texas School of Public Health, Houston, Texas, USA
| | - Ruosha Li
- University of Texas School of Public Health, Houston, Texas, USA
| | - Jagat Narula
- Mount Sinai Heart at Mount Sinai Morningside and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nils P Johnson
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, Texas, USA
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Johnson DT, Svanerud J, Ahn JM, Bezerra HG, Collison D, van 't Veer M, Hennigan B, De Bruyne B, Kirkeeide RL, Gould KL, Johnson NP. Use of a Pressure Wire for Automatically Correcting Artifacts in Phasic Pressure Tracings From a Fluid-Filled Catheter. Cardiovasc Revasc Med 2023; 46:98-105. [PMID: 35918253 DOI: 10.1016/j.carrev.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Matching phasic pressure tracings between a fluid-filled catheter and high-fidelity pressure wire has received limited attention, although each part contributes half of the information to clinical decisions. We aimed to study the impact of a novel and automated method for improving the phasic calibration of a fluid-filled catheter by accounting for its oscillatory behavior. METHODS/MATERIALS Retrospective analysis of drift check tracings was performed using our algorithm that corrects for mean difference (offset), temporal delays (timing), differential sensitivity of the manifold transducer and pressure wire sensor (gain), and the oscillatory behavior of the fluid-filled catheter described by its resonant frequency and damping factor (how quickly oscillations disappear after a change in pressure). RESULTS Among 2886 cases, correcting for oscillations showed a large improvement in 28 % and a medium improvement in 41 % (decrease in root mean square error >0.5 mmHg to <1 or 1-2 mmHg, respectively). 96 % of oscillators were underdamped with median damping factor 0.27 and frequency 10.6 Hz. Fractional flow reserve or baseline Pd/Pa demonstrated no clinically important bias when ignoring oscillations. However, uncorrected subcycle non-hyperemic pressure ratios (NHPR) displayed both bias and scatter. CONCLUSIONS By automatically accounting for the oscillatory behavior of a fluid-filled catheter system, phasic matching against a high-fidelity pressure wire can be improved compared to standard equalization methods. The majority of tracings contain artifacts, mainly due to underdamped oscillations, and neglecting them leads to biased estimates of equalization parameters. No clinically important bias exists for whole-cycle metrics, in contrast to significant effects on subcycle NHPR.
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Affiliation(s)
- Daniel T Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | | | | | | | | | - Marcel van 't Veer
- Catharina Hospital and Eindhoven University of Technology, Eindhoven, Netherlands
| | - Barry Hennigan
- Mater Private Hospital and University College, Cork, Ireland
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America.
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Johnson NP, Gould KL. Retention models: 'tis the gift to be simple. J Nucl Cardiol 2022; 29:2595-2598. [PMID: 34657979 DOI: 10.1007/s12350-021-02827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA.
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
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11
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Johnson NP, Gould KL. How shall we judge a PET flow model? J Nucl Cardiol 2022; 29:2551-2554. [PMID: 34561847 DOI: 10.1007/s12350-021-02805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX, USA.
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX, USA
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12
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Eftekhari A, Westra J, Stegehuis V, Holm NR, van de Hoef TP, Kirkeeide RL, Piek JJ, Lance Gould K, Johnson NP, Christiansen EH. Prognostic value of microvascular resistance and its association to fractional flow reserve: a DEFINE-FLOW substudy. Open Heart 2022; 9:openhrt-2022-001981. [PMID: 35410913 PMCID: PMC9003618 DOI: 10.1136/openhrt-2022-001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to evaluate the prognostic value of hyperemic microvascular resistance (HMR) and its relationship with hyperemic stenosis resistance (HSR) index and fractional flow reserve (FFR) in stable coronary artery disease. Methods This is a substudy of the DEFINE-FLOW cohort (NCT02328820), which evaluated the prognosis of lesions (n=456) after combined FFR and coronary flow reserve (CFR) assessment in a prospective, non-blinded, non-randomised, multicentre study in 12 centres in Europe and Japan. Participants (n=430) were evaluated by wire-based measurement of coronary pressure, flow and vascular resistance (ComboWire XT, Phillips Volcano, San Diego, California, USA). Results Mean FFR and CFR were 0.82±0.10 and 2.2±0.6, respectively. When divided according to FFR and CFR thresholds (above and below 0.80 and 2.0, respectively), HMR was highest in lesions with FFR>0.80 and CFR<2.0 (n=99) compared with lesions with FFR≤0.80 and CFR≥2.0 (n=68) (2.92±1.2 vs 1.91±0.64 mm Hg/cm/s, p<0.001). The FFR value was proportional to the ratio between HMR and the HMR+HSR (total resistance), 95% limits of agreement (−0.032; 0.019), bias (−0.003±0.02) and correlation (r2=0.98, p<0.0001). Cox regression model using HMR as continuous parameter for target vessel failure showed an HR of 1.51, 95% CI (0.9 to 2.4), p=0.10. Conclusions Increased HMR was not associated with a higher rate of adverse clinical events, in this population of mainly stable patients. FFR can be equally well expressed as HMR/HMR+HSR, thereby providing an alternative conceptual formulation linking epicardial severity with microvascular resistance. Trial registration number NCT02328820.
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Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Valérie Stegehuis
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Tim P van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
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13
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Zimmermann FM, Pijls NHJ, Gould KL, Johnson NP. Stenting "Vulnerable" But Fractional Flow Reserve-Negative Lesions: Potential Statistical Limitations of Ongoing and Future Trials. JACC Cardiovasc Interv 2021; 14:461-467. [PMID: 33602443 DOI: 10.1016/j.jcin.2020.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022]
Abstract
Can imaging provide sufficient risk stratification to warrant revascularization of a stable plaque with negative fractional flow reserve (FFR)? Prophylactic stenting could at best be applied selectively since the composite group of FFR-negative lesions has a death or myocardial infarction rate of approximately 1%/year or less but modern stents have a rate of 2% to 3.5%/year. Because vulnerable features exist in a minority of lesions, at least 9,000 patients must be screened in order to enroll a cohort with sufficient risk. While several ongoing randomized trials are testing the concept of plaque sealing in FFR-negative lesions, preventive stenting depends on such a small effect that sample sizes to validate or refute its benefit become prohibitive. Since FFR provides a quantitative, straightforward, and reproducible metric of plaque vulnerability and burden without the need for or expense of additional catheter devices, intracoronary imaging cannot meaningfully guide prophylactic stenting when faced with a negative FFR.
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Affiliation(s)
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA.
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14
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Gould KL, Johnson NP. A fundamental principle of coronary pathophysiology for risk stratifying coronary artery disease. Eur Heart J Cardiovasc Imaging 2021; 22:647-649. [PMID: 33313785 DOI: 10.1093/ehjci/jeaa333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX, USA
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX, USA
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15
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Johnson NP, Gould KL. Potential errors in interpreting hibernation due to FDG scaling? J Nucl Cardiol 2021; 28:1740-1744. [PMID: 31732874 DOI: 10.1007/s12350-019-01953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA.
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
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16
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Affiliation(s)
- Nils P Johnson
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
| | - Richard L Kirkeeide
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
| | - K Lance Gould
- Division of Cardiology Department of Medicine Weatherhead PET CenterMcGovern Medical School at UTHealth and Memorial Hermann Hospital Houston TX
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17
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Johnson NP, Gould KL, De Bruyne B. Autoregulation of Coronary Blood Supply in Response to Demand: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:2335-2345. [PMID: 33958131 DOI: 10.1016/j.jacc.2021.03.293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Although our coronary circulation evolved to meet demands during marked physical exertion for "fight or flight" survival, complex and multilayered control mechanisms reduce flow during other periods. Understanding homeostasis of resting flow provides essential insights into clinical pathophysiology. Several homeostatic mechanisms (myogenic, metabolic, endothelial, and neural) maintain sufficient baseline flow regardless of driving pressure (in aggregate, "autoregulation"). As a result, ventricular dysfunction does not arise until coronary perfusion pressure decreases to ∼40 mm Hg. Straightforward clinical parameters explain approximately one-half of observed absolute resting perfusion but with wide imprecision. Resting perfusion does not associate with clinical outcomes and remains unaffected by revascularization, recovery after myocardial infarction, and treating severe aortic stenosis, thereby supporting the notion that the heart was designed for peak performance.
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA.
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
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18
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Zheng W, Lai D, Gould KL. A simulation study of a class of nonparametric test statistics: a close look of empirical distribution function-based tests. COMMUN STAT-SIMUL C 2021. [DOI: 10.1080/03610918.2021.1874987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Wenjun Zheng
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Dejian Lai
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - K. Lance Gould
- Weatherhead PET Imaging Center, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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19
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Gould KL, Bui L, Kitkungvan D, Patel MB. Reliability and Reproducibility of Absolute Myocardial Blood Flow: Does It Depend on the PET/CT Technology, the Vasodilator, and/or the Software? Curr Cardiol Rep 2021; 23:12. [PMID: 33483794 PMCID: PMC7822783 DOI: 10.1007/s11886-021-01449-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE OF REVIEW The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? RECENT FINDINGS Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull's-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.
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Affiliation(s)
- K. Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, Houston, TX USA
| | - Monica B. Patel
- Division of Cardiology, McGovern Medical School, Houston, TX USA
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20
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Gould KL, Kitkungvan D, Johnson NP, Nguyen T, Kirkeeide R, Bui L, Patel MB, Roby AE, Madjid M, Zhu H, Lai D. Mortality Prediction by Quantitative PET Perfusion Expressed as Coronary Flow Capacity With and Without Revascularization. JACC Cardiovasc Imaging 2020; 14:1020-1034. [PMID: 33221205 DOI: 10.1016/j.jcmg.2020.08.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to determine the relationship between the severity of reduced quantitative perfusion parameters and mortality with and without revascularization. BACKGROUND The physiological mechanisms for differential mortality risk of coronary flow reserve (CFR) and coronary flow capacity (CFC) before and after revascularization are unknown. METHODS Global and regional rest-stress (ml/min/g), CFR, their regional per-pixel combination as CFC, and relative stress in ml/min/g were measured as percent of LV in all serial routine 5,274 diagnostic PET scans with systematic follow-up over 10 years (mean 4.2 ± 2.5 years) for all-cause mortality with and without revascularization. RESULTS Severely reduced CFR of 1.0 to 1.5 and stress perfusion ≤1.0 cc/min/g incurred increasing size-dependent risks that were additive because regional severely reduced CFC (CFCsevere) was associated with the highest major adverse cardiac event rate of 80% (p < 0.0001 vs. either alone) and a mortality risk of 14% (vs. 2.3% for no CFCsevere; p = 0.001). Small regions of CFCsevere ≤0.5% predicted high risk (p < 0.0001 vs. no CFCsevere) related to a wave front of border zones at risk around the small most severe center. By receiver-operating characteristic analysis, relative stress topogram maps of stress (ml/min/g) as a fraction of LV defined these border zones at risk or for mildly reduced CFC (area under the curve [AUC]: 0.69) with a reduced relative tomographic subendocardial-to-subepicardial ratio. CFCsevere incurred the highest mortality risk that was reduced by revascularization (p = 0.005 vs. no revascularization) for artery-specific stenosis not defined by global CFR or stress perfusion alone. CONCLUSIONS CFC is associated with the size-dependent highest mortality risk resulting from the additive risk of CFR and stress (ml/min/g) that is significantly reduced after revascularization, a finding not seen for global CFR. Small regions of CFCsevere ≤0.5% of LV also carry a high risk because of the surrounding border zones at risk defined by relative stress perfusion and a reduced relative subendocardial-to-subepicardial ratio.
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Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
| | - Danai Kitkungvan
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Tung Nguyen
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard Kirkeeide
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Linh Bui
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Monica B Patel
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Amanda E Roby
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Hongjian Zhu
- University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas, USA
| | - Dejian Lai
- University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas, USA
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21
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Gould KL. FFR at high heart rate - Unexpected physiologic insights. Int J Cardiol 2020; 317:44-46. [PMID: 32663484 DOI: 10.1016/j.ijcard.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- K Lance Gould
- Martin Bucksbaum Distinguished University Chair, Cardiovascular Medicine, Professor of Cardiovascular Medicine and Executive Director, University of Texas Medical School, 6431 Fannin St., Rm 4.256MSB, Houston, TX 77030, United States.
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Johnson DT, Fournier S, Kirkeeide RL, De Bruyne B, Gould KL, Johnson NP. Phasic pressure measurements for coronary and valvular interventions using fluid-filled catheters: Errors, automated correction, and clinical implications. Catheter Cardiovasc Interv 2020; 96:E268-E277. [PMID: 32077561 PMCID: PMC7539962 DOI: 10.1002/ccd.28780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
Objectives We sought to develop an automatic method for correcting common errors in phasic pressure tracings for physiology‐guided interventions on coronary and valvular stenosis. Background Effective coronary and valvular interventions rely on accurate hemodynamic assessment. Phasic (subcycle) indexes remain intrinsic to valvular stenosis and are emerging for coronary stenosis. Errors, corrections, and clinical implications of fluid‐filled catheter phasic pressure assessments have not been assessed in the current era of ubiquitous, high‐fidelity pressure wire sensors. Methods We recruited patients undergoing invasive coronary physiology assessment. Phasic aortic pressure signals were recorded simultaneously using a fluid‐filled guide catheter and 0.014″ pressure wire before and after standard calibration as well as after pullback. We included additional subjects undergoing hemodynamic assessment before and after transcatheter aortic valve implantation. Using the pressure wire as reference standard, we developed an automatic algorithm to match phasic pressures. Results Removing pressure offset and temporal shift produced the largest improvements in root mean square (RMS) error between catheter and pressure wire signals. However, further optimization <1 mmHg RMS error was possible by accounting for differential gain and the oscillatory behavior of the fluid‐filled guide. The impact of correction was larger for subcycle (like systole or diastole) versus whole‐cycle metrics, indicating a key role for valvular stenosis and emerging coronary pressure ratios. Conclusions When calibrating phasic aortic pressure signals using a pressure wire, correction requires these parameters: offset, timing, gain, and oscillations (frequency and damping factor). Automatically eliminating common errors may improve some clinical decisions regarding physiology‐based intervention.
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Affiliation(s)
- Daniel T Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Stephane Fournier
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium.,Department of Cardiology, Lausanne University Center Hospital, Switzerland
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
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Murai T, Stegehuis VE, van de Hoef TP, Wijntjens GWM, Hoshino M, Kanaji Y, Sugiyama T, Hamaya R, Nijjer SS, de Waard GA, Echavarria‐Pinto M, Knaapen P, Meuwissen M, Davies JE, van Royen N, Escaned J, Siebes M, Kirkeeide RL, Gould KL, Johnson NP, Piek JJ, Kakuta T. Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL. J Am Heart Assoc 2020; 9:e016130. [PMID: 32660310 PMCID: PMC7660740 DOI: 10.1161/jaha.120.016130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023]
Abstract
Background Coronary flow capacity (CFC), which is a categorical assessment based on the combination of hyperemic coronary flow and coronary flow reserve (CFR), has been introduced as a comprehensive assessment of the coronary circulation to overcome the limitations of CFR alone. The aim of this study was to quantify coronary flow changes after percutaneous coronary intervention in relation to the classification of CFC and the current physiological cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR. Methods and Results Using the combined data set from DEFINE FLOW (Distal Evaluation of Functional Performance With Intravascular Sensors to Assess the Narrowing Effect -Combined Pressure and Doppler FLOW Velocity Measurements) and IDEAL (Iberian-Dutch-English), a total of 133 vessels that underwent intracoronary Doppler flow measurement before and after percutaneous coronary intervention were analyzed. CFC classified prerevascularization lesions as normal (14), mildly reduced (40), moderately reduced (31), and severely reduced (48). Lesions with larger impairment of CFC showed greater increase in coronary flow and vice versa (median percent increase in coronary flow by revascularization: 4.2%, 25.9%, 50.1%, and 145.5%, respectively; P<0.001). Compared with the conventional cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR, an ischemic CFC defined as moderately to severely reduced CFC showed higher diagnostic accuracy with higher specificity to predict a >50% increase in coronary flow after percutaneous coronary intervention. Receiver operating characteristic curve analysis demonstrated that only CFC has a superior predictive efficacy to CFR (P<0.05). Multivariate analysis revealed lesions with ischemic CFC to be the independent predictor of a significant coronary flow increase after percutaneous coronary intervention (odds ratio, 10.7; 95% CI, 4.6-24.8; P<0.001). Conclusions CFC showed significant improvement of identification of lesions that benefit from revascularization compared with CFR with respect to coronary flow increase. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02328820.
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Affiliation(s)
| | | | | | | | - Masahiro Hoshino
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yoshihisa Kanaji
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tomoyo Sugiyama
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Rikuta Hamaya
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Sukhjinder S. Nijjer
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Guus A. de Waard
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Paul Knaapen
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Justin E. Davies
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Niels van Royen
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Javier Escaned
- Department of CardiologyHospital Clinico San Carlos IDISSC, and Universidad Complutense de MadridMadridSpain
| | - Maria Siebes
- Department of Biomedical Engineering and PhysicsAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Richard L. Kirkeeide
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - K. Lance Gould
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Nils P. Johnson
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Jan J. Piek
- Heart CenterAmsterdam UMCAmsterdamThe Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
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Sudasena D, Balanescu DV, Donisan T, Hassan S, Palaskas N, Kim P, Karimzad K, Lopez-Mattei J, Arain S, Gould KL, Iliescu C. Fulminant Vascular and Cardiac Toxicity Associated with Tyrosine Kinase Inhibitor Sorafenib. Cardiovasc Toxicol 2020; 19:382-387. [PMID: 30543051 DOI: 10.1007/s12012-018-9499-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The use of vascular endothelial growth factor inhibitors such as sorafenib is limited by a risk of severe cardiovascular toxicity. A 28-year-old man with acute myeloid leukemia treated with prednisone, tacrolimus, and sorafenib following stem cell transplantation presented with severe bilateral lower extremity claudication. The patient was discharged against medical advice prior to finalizing a cardiovascular evaluation, but returned 1 week later with signs suggestive of septic shock. Laboratory tests revealed troponin I of 12.63 ng/mL, BNP of 1690 pg/mL, and negative infectious workup. Electrocardiogram showed sinus tachycardia and new pathologic Q waves in the anterior leads. Coronary angiography revealed severe multivessel coronary artery disease. Peripheral angiography revealed severely diseased left anterior and posterior tibial arteries, tibioperoneal trunk, and peroneal artery, and subtotal occlusion of the right posterior tibial artery. Multiple coronary and peripheral drug-eluting stents were implanted. An intra-aortic balloon pump was placed. Cardiac magnetic resonance imaging revealed chronic left ventricular infarction with some viability, 17% ejection fraction, and left ventricular mural thrombi. The patient opted for medical management. Persistent symptoms 9 months later led to repeat angiography, showing total occlusion of the second obtuse marginal artery due to in-stent restenosis with proximal stent fracture, and chronic total occlusion of the right internal iliac artery extending to the pudendal branch. Cardiac positron emission tomography/computed tomography viability study demonstrated viable myocardium, deeming revascularization appropriate. Symptom resolution was obtained with no recurrences. Sorafenib-associated vasculopathy may follow a fulminant course. Multimodality cardiovascular imaging is essential for optimal management.
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Affiliation(s)
- Daryl Sudasena
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA
| | - Salman Arain
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Lance Gould
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, 1451, 77030, Houston, TX, USA.
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25
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Lance Gould K, Bui L, Kitkungvan D, Pan T, Roby AE, Nguyen TT, Johnson NP. Pitfalls in quantitative myocardial PET perfusion I: Myocardial partial volume correction. J Nucl Cardiol 2020; 27:386-396. [PMID: 32095938 PMCID: PMC7174249 DOI: 10.1007/s12350-020-02073-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND PET quantitative myocardial perfusion requires correction for partial volume loss due to one-dimensional LV wall thickness smaller than scanner resolution. METHODS We aimed to assess accuracy of risk stratification for death, MI, or revascularization after PET using partial volume corrections derived from two-dimensional ACR and three-dimensional NEMA phantoms for 3987 diagnostic rest-stress perfusion PETs and 187 MACE events. NEMA, ACR, and Tree phantoms were imaged with Rb-82 or F-18 for size-dependent partial volume loss. Perfusion and Coronary Flow Capacity were recalculated using different ACR- and NEMA-derived partial volume corrections compared by Kolmogorov-Smirnov statistics to standard perfusion metrics with established correlations with MACE. RESULTS Partial volume corrections based on two-dimensional ACR rods (two equal radii) and three-dimensional NEMA spheres (three equal radii) over estimate partial volume corrections, quantitative perfusion, and Coronary Flow Capacity by 50% to 150% over perfusion metrics with one-dimensional partial volume correction, thereby substantially impairing correct risk stratification. CONCLUSIONS ACR (2-dimensional) and NEMA (3-dimensional) phantoms overestimate partial volume corrections for 1-dimensional LV wall thickness and myocardial perfusion that are corrected with a simple equation that correlates with MACE for optimal risk stratification applicable to most PET-CT scanners for quantifying myocardial perfusion.
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Affiliation(s)
- K Lance Gould
- Martin Bucksbaum Distinguished University Chair, Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX, 77030, USA.
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA.
| | - Linh Bui
- Division of Cardiology, McGovern Medical School, UT Health - Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Danai Kitkungvan
- Division of Cardiology, McGovern Medical School, UT Health - Houston, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Tinsu Pan
- Imaging Physics Department, MD Anderson Cancer, University of Texas, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Amanda E Roby
- Weatherhead PET Center, McGovern Medical School, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Tung T Nguyen
- Programming and Data Management, Weatherhead P.E.T. Center, McGovern Medical School, University of Texas, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
| | - Nils P Johnson
- Weatherhead Distinguished Chair of Heart Disease, Division of Cardiology, McGovern Medical School, Houston, TX, USA
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston, TX, USA
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26
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Stegehuis VE, Wijntjens GW, van de Hoef TP, Casadonte L, Kirkeeide RL, Siebes M, Spaan JA, Gould KL, Johnson NP, Piek JJ. Distal Evaluation of Functional performance with Intravascular sensors to assess the Narrowing Effect-combined pressure and Doppler FLOW velocity measurements (DEFINE-FLOW) trial: Rationale and trial design. Am Heart J 2020; 222:139-146. [PMID: 32062172 DOI: 10.1016/j.ahj.2019.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND It remains uncertain if invasive coronary physiology beyond fractional flow reserve (FFR) can refine lesion selection for revascularization or provide additional prognostic value. Coronary flow reserve (CFR) equals the ratio of hyperemic to baseline flow velocity and has a wealth of invasive and noninvasive data supporting its validity. Because of fundamental physiologic relationships, binary classification of FFR and CFR disagrees in approximately 30%-40% of cases. Optimal management of these discordant cases requires further study. AIM The aim of the study was to determine the prognostic value of combined FFR and CFR measurements to predict the 24-month rate of major adverse cardiac events. Secondary end points include repeatability of FFR and CFR, angina burden, and the percentage of successful FFR/CFR measurements which will not be excluded by the core laboratory. METHODS This prospective, nonblinded, nonrandomized, and multicenter study enrolled 455 subjects from 12 sites in Europe and Japan. Patients underwent physiologic lesion assessment using the 0.014" Philips Volcano ComboWire XT that provides simultaneous pressure and Doppler velocity sensors. Intermediate coronary lesions received only medical treatment unless both FFR (≤0.8) and CFR (<2.0) were below thresholds. The primary outcome is a 24-month composite of death from any cause, myocardial infarction, and revascularization. CONCLUSION The DEFINE-FLOW study will determine the prognostic value of invasive CFR assessment when measured simultaneously with FFR, with a special emphasis on discordant classifications. Our hypothesis is that lesions with an intact CFR ≥ 2.0 but reduced FFR ≤ 0.8 will have a 2-year outcome with medical treatment similar to lesions with FFR> 0.80 and CFR ≥ 2.0. Enrollment has been completed, and final follow-up will occur in November 2019.
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27
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Bui L, Kitkungvan D, Roby AE, Nguyen TT, Gould KL. Pitfalls in quantitative myocardial PET perfusion II: Arterial input function. J Nucl Cardiol 2020; 27:397-409. [PMID: 32128675 PMCID: PMC7174279 DOI: 10.1007/s12350-020-02074-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 12/02/2022]
Abstract
RATIONALE We aimed to define the impact of variable arterial input function on myocardial perfusion severity that may misguide interventional decisions and relates to limited capacity of 3D PET for high-count arterial input function of standard bolus R-82. METHODS We used GE Discovery-ST 16 slice PET-CT, serial 2D and 3D acquisitions of variable Rb-82 dose in a dynamic circulating arterial function model, static resolution and uniformity phantoms, and in patients with dipyridamole stress to quantify per-pixel rest and stress cc·min-1·g-1, CFR and CFC with (+) and (-) 10% simulated change in arterial input. RESULTS For intermediate, border zone severity of stress perfusion, CFR and CFC comprising 7% of 3987 cases, simulated arterial input variability of ± 10% may cause over or underestimation of perfusion severity altering interventional decisions. In phantom tests, current 3D PET has capacity for quantifying high activity of arterial input and high-count per-pixel values of perfusion metrics per artery or branches. CONCLUSIONS Accurate, reproducible arterial input function is essential for at least 7% of patients at thresholds of perfusion severity for optimally guiding interventions and providing high-activity regional per-pixel perfusion metrics by 3D PET for displaying complex quantitative perfusion readily understood ("owned") by interventionalists to guide procedures.
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Affiliation(s)
- Linh Bui
- Department of Medicine, Division of Cardiology and Weatherhead PET Center For Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Danai Kitkungvan
- Department of Medicine, Division of Cardiology and Weatherhead PET Center For Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Amanda E. Roby
- Weatherhead PET Center for Preventing Atherosclerosis, McGovern Medical School and Memorial Hermann Hospital, Houston, TX USA
| | - Tung T. Nguyen
- Programming and Data Management, Weatherhead PET Center, McGovern Medical School, University of Texas, Houston, TX USA
| | - K. Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX 77030 USA
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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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29
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Johnson NP, Zelis JM, Tonino PAL, Houthuizen P, Bouwman RA, Brueren GRG, Johnson DT, Koolen JJ, Korsten HHM, Wijnbergen IF, Zimmermann FM, Kirkeeide RL, Pijls NHJ, Gould KL. Pressure gradient vs. flow relationships to characterize the physiology of a severely stenotic aortic valve before and after transcatheter valve implantation. Eur Heart J 2019; 39:2646-2655. [PMID: 29617762 PMCID: PMC6055586 DOI: 10.1093/eurheartj/ehy126] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/23/2018] [Indexed: 11/14/2022] Open
Abstract
Aims Echocardiography and tomographic imaging have documented dynamic changes in aortic stenosis (AS) geometry and severity during both the cardiac cycle and stress-induced increases in cardiac output. However, corresponding pressure gradient vs. flow relationships have not been described. Methods and results We recruited 16 routine transcatheter aortic valve implantations (TAVI’s) for graded dobutamine infusions both before and after implantation; 0.014″ pressure wires in the aorta and left ventricle (LV) continuously measured the transvalvular pressure gradient (ΔP) while a pulmonary artery catheter regularly assessed cardiac output by thermodilution. Before TAVI, ΔP did not display a consistent relationship with transvalvular flow (Q). Neither linear resistor (median R2 0.16) nor quadratic orifice (median R2 < 0.01) models at rest predicted stress observations; the severely stenotic valve behaved like a combination. The unitless ratio of aortic to left ventricular pressures during systolic ejection under stress conditions correlated best with post-TAVI flow improvement. After TAVI, a highly linear relationship (median R2 0.96) indicated a valid valve resistance. Conclusion Pressure loss vs. flow curves offer a fundamental fluid dynamic synthesis for describing aortic valve pathophysiology. Severe AS does not consistently behave like an orifice (as suggested by Gorlin) or a resistor, whereas TAVI devices behave like a pure resistor. During peak dobutamine, the ratio of aortic to left ventricular pressures during systolic ejection provides a ‘fractional flow reserve’ of the aortic valve that closely approximates the complex, changing fluid dynamics. Because resting assessment cannot reliably predict stress haemodynamics, ‘valvular fractional flow’ warrants study to explain exertional symptoms in patients with only moderate AS at rest. ![]()
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA.,Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Jo M Zelis
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Guus R G Brueren
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Daniel T Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
| | - Jacques J Koolen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Hendrikus H M Korsten
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Inge F Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
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30
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Zelis JM, Tonino PAL, Johnson DT, Balan P, Brueren GRG, Wijnbergen I, Kirkeeide RL, Pijls NHJ, Gould KL, Johnson NP. Stress Aortic Valve Index (SAVI) with Dobutamine for Low-Gradient Aortic Stenosis: A Pilot Study. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1690180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jo M. Zelis
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Pim A. L. Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Daniel T. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Prakash Balan
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | | | - Inge Wijnbergen
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Richard L. Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nico H. J. Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - K. Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
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Gould KL, Nguyen T, Johnson NP. Integrating Coronary Physiology, Longitudinal Pressure, and Perfusion Gradients in CAD: Measurements, Meaning, and Mortality. J Am Coll Cardiol 2019; 74:1785-1788. [PMID: 31582138 DOI: 10.1016/j.jacc.2019.07.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/09/2019] [Accepted: 07/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- K Lance Gould
- Department of Medicine, Weatherhead P.E.T. Center for Preventing and Reversing Atherosclerosis, University of Texas Medical School at Houston, Houston, Texas.
| | - Tung Nguyen
- Division of Cardiology, University of Texas Medical School at Houston, Houston, Texas
| | - Nils P Johnson
- Division of Cardiology, University of Texas Medical School at Houston, Houston, Texas
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Kitkungvan D, Bui L, Johnson NP, Patel MB, Roby AE, Vejpongsa P, Babar AK, Madjid M, Nacimbene A, Kumar S, DeGolovine A, Gould KL. Quantitative myocardial perfusion positron emission tomography and caffeine revisited with new insights on major adverse cardiovascular events and coronary flow capacity. Eur Heart J Cardiovasc Imaging 2019; 20:751-762. [DOI: 10.1093/ehjci/jez080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/09/2019] [Accepted: 04/02/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Danai Kitkungvan
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Linh Bui
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Nils P Johnson
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Monica B Patel
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Amanda E Roby
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Pimprapa Vejpongsa
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Asim K Babar
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Mohammad Madjid
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Angelo Nacimbene
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Sachin Kumar
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - Alexandra DeGolovine
- Division of Renal Disease and Hypertension, Department of Medicine, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
| | - K Lance Gould
- Division of Cardiology and Weatherhead PET Center, McGovern Medical School, UT Health, 6431 Fannin St., and Memorial Hermann Hospital, 6411 Fannin St., Houston, TX, USA
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Johnson NP, Kirkeeide RL, Gould KL. Same Lesion, Different Artery, Different FFR!? JACC Cardiovasc Imaging 2019; 12:718-721. [DOI: 10.1016/j.jcmg.2017.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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Affiliation(s)
- K Lance Gould
- From Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School and Memorial Hermann Hospital, Houston, TX.
| | - Nils P Johnson
- From Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School and Memorial Hermann Hospital, Houston, TX
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35
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Affiliation(s)
- K Lance Gould
- Division of Cardiology, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, McGovern Medical School at UTHealth and Memorial Hermann Hospital, 6431 Fannin St., Room MSB 4.256, Houston, TX, USA
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36
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Affiliation(s)
- K. Lance Gould
- From the Division of Cardiology, Weatherhead PET Center, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX
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37
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Affiliation(s)
- K Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas.
| | - Nils P Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Kirkeeide
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, Department of Cardiothoracic Vascular Surgery, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
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Gould KL, Johnson NP, Roby AE, Nguyen T, Kirkeeide R, Haynie M, Lai D, Zhu H, Patel MB, Smalling R, Arain S, Balan P, Nguyen T, Estrera A, Sdringola S, Madjid M, Nascimbene A, Loyalka P, Kar B, Gregoric I, Safi H, McPherson D. Regional, Artery-Specific Thresholds of Quantitative Myocardial Perfusion by PET Associated with Reduced Myocardial Infarction and Death After Revascularization in Stable Coronary Artery Disease. J Nucl Med 2018; 60:410-417. [PMID: 30115688 PMCID: PMC6424226 DOI: 10.2967/jnumed.118.211953] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022] Open
Abstract
Because randomized coronary revascularization trials in stable coronary artery disease (CAD) have shown no reduced myocardial infarction (MI) or mortality, the threshold of quantitative myocardial perfusion severity was analyzed for association with reduced death, MI, or stroke after revascularization within 90 d after PET. Methods: In a prospective long-term cohort of stable CAD, regional, artery-specific, quantitative myocardial perfusion by PET, coronary revascularization within 90 d after PET, and all-cause death, MI, and stroke (DMS) at 9-y follow-up (mean ± SD, 3.0 ± 2.3 y) were analyzed by multivariate Cox regression models and propensity analysis. Results: For 3,774 sequential rest–stress PET scans, regional, artery-specific, severely reduced coronary flow capacity (CFC) (coronary flow reserve ≤ 1.27 and stress perfusion ≤ 0.83 cc/min/g) associated with 60% increased hazard ratio for major adverse cardiovascular events and 30% increased hazard of DMS that was significantly reduced by 54% associated with revascularization within 90 d after PET (P = 0.0369), compared with moderate or mild CFC, coronary flow reserve, other PET metrics or medical treatment alone. Depending on severity threshold for statistical certainty, up to 19% of this clinical cohort had CFC severity associated with reduced DMS after revascularization. Conclusion: CFC by PET provides objective, regional, artery-specific, size–severity physiologic quantification of CAD severity associated with high risk of DMS that is significantly reduced after revascularization within 90 d after PET, an association not seen for moderate to mild perfusion abnormalities or medical treatment alone.
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Affiliation(s)
- K Lance Gould
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Nils P Johnson
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Amanda E Roby
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Tung Nguyen
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Kirkeeide
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Mary Haynie
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Dejian Lai
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston Texas
| | - Hongjian Zhu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Houston Texas
| | - Monica B Patel
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Richard Smalling
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Sal Arain
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Prakash Balan
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Tom Nguyen
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - Anthony Estrera
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - Stefano Sdringola
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Mohammad Madjid
- Division of Cardiology, Department of Medicine, McGovern Medical School, Weatherhead PET Center for Preventing and Reversing Atherosclerosis, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Pranav Loyalka
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | - Hazem Safi
- Department of Cardiothoracic Vascular Surgery, McGovern Medial School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas; and
| | - David McPherson
- Division of Cardiology, Department of Medicine, McGovern Medial Medical School, University of Texas Health Science Center and Memorial Hermann Hospital, Houston, Texas
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Nishi T, Johnson NP, De Bruyne B, Berry C, Gould KL, Jeremias A, Oldroyd KG, Kobayashi Y, Choi DH, Pijls NHJ, Fearon WF. Influence of Contrast Media Dose and Osmolality on the Diagnostic Performance of Contrast Fractional Flow Reserve. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.004985. [PMID: 29042397 DOI: 10.1161/circinterventions.117.004985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/15/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Contrast fractional flow reserve (cFFR) is a method for assessing functional significance of coronary stenoses, which is more accurate than resting indices and does not require adenosine. However, contrast media volume and osmolality may affect the degree of hyperemia and therefore diagnostic performance. METHODS AND RESULTS cFFR, instantaneous wave-free ratio, distal pressure/aortic pressure at rest, and FFR were measured in 763 patients from 12 centers. We compared the diagnostic performance of cFFR between patients receiving low or iso-osmolality contrast (n=574 versus 189) and low or high contrast volume (n=341 versus 422) using FFR≤0.80 as a reference standard. The sensitivity, specificity, and overall accuracy of cFFR for the low versus iso-osmolality groups were 73%, 93%, and 85% versus 87%, 90%, and 89%, and for the low versus high contrast volume groups were 69%, 99%, and 83% versus 82%, 93%, and 88%. By receiver operating characteristics (ROC) analysis, cFFR provided better diagnostic performance than resting indices regardless of contrast osmolality and volume (P<0.001 for all groups). There was no significant difference between the area under the curve of cFFR in the low- and iso-osmolality groups (0.938 versus 0.957; P=0.40) and in the low- and high-volume groups (0.939 versus 0.949; P=0.61). Multivariable logistic regression analysis showed that neither contrast osmolality nor volume affected the overall accuracy of cFFR; however, both affected the sensitivity and specificity. CONCLUSIONS The overall accuracy of cFFR is greater than instantaneous wave-free ratio and distal pressure/aortic pressure and not significantly affected by contrast volume and osmolality. However, contrast volume and osmolality do affect the sensitivity and specificity of cFFR. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02184117.
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Affiliation(s)
- Takeshi Nishi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nils P Johnson
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Bernard De Bruyne
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Colin Berry
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - K Lance Gould
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Allen Jeremias
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Keith G Oldroyd
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Yuhei Kobayashi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Dong-Hyun Choi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nico H J Pijls
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - William F Fearon
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.).
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Affiliation(s)
- Joseph L. Demer
- Jules Stein Eye Institute and Department of Neurology, UCLA, Los Angeles, California
| | - Gunter K. von Noorden
- Texas Children's Hospital, Houston, Texas
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Nora D. Volkow
- Positron Diagnostic and Reseach Center, University of Texas Health Science Center at Houston, Houston, Texas
- Present address: Department of Medicine, Brookhaven National Laboratory, Upton, New York
| | - K. Lance Gould
- Positron Diagnostic and Reseach Center, University of Texas Health Science Center at Houston, Houston, Texas
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Gould KL. Optimizing quantitative myocardial perfusion by positron emission tomography for guiding CAD management. J Nucl Cardiol 2017; 24:1950-1954. [PMID: 27638746 DOI: 10.1007/s12350-016-0666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Affiliation(s)
- K Lance Gould
- Weatherhead PET Center for Preventing and Reversing Atherosclerosis, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St., Room MSB 4.256, Houston, TX, 77030, USA.
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Gould KL, Johnson NP. Coronary CT Angiography With PET Perfusion Imaging. JACC Cardiovasc Imaging 2017; 10:1371-1373. [DOI: 10.1016/j.jcmg.2016.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/26/2022]
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Johnson N, Zelis J, Tonino P, Houthuizen P, Zimmermann F, Bouwman A, Brueren G, Johnson D, Koolen JJ, Korsten E, Wijnbergen I, Kirkeeide RL, Pijls N, Gould KL. TCT-279 Baseline and dobutamine stress hemodynamic physiology of the stenotic aortic valve before and after transcatheter valve implantation. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Johnson NP, Gould KL, Di Carli MF, Taqueti VR. Invasive FFR and Noninvasive CFR in the Evaluation of Ischemia: What Is the Future? J Am Coll Cardiol 2017; 67:2772-2788. [PMID: 27282899 DOI: 10.1016/j.jacc.2016.03.584] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/14/2022]
Abstract
This review provides an integrative and forward-looking perspective on the gamut of coronary physiology for the diagnosis and management of atherosclerosis. Because clinical events serve as the ultimate gold standard, the future of all diagnostic tests, including invasive fractional flow reserve and noninvasive coronary flow reserve, depends on their ability to improve patient outcomes. Given the prominent role of acute coronary syndromes and invasive procedures in cardiology, we practically consider 2 broad categories of patients with coronary disease: acute and stable. For patients with acute coronary disease, coronary physiology may potentially refine treatment of the culprit lesion. For both patients with stable and acute nonculprit disease, reducing hard endpoints with revascularization potentially occurs at the severe end of the focal physiological spectrum, an area under-represented in existing trials. Nonepicardial disease and diffuse atherosclerosis remain underexplored aspects of coronary physiology for testing of novel treatments.
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Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas.
| | - K Lance Gould
- Weatherhead PET Center For Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Marcelo F Di Carli
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Viviany R Taqueti
- Departments of Medicine and Radiology, Noninvasive Cardiovascular Imaging Program, Heart and Vascular Institute, Division of Cardiovascular Medicine, Department of Medicine, and the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kitkungvan D, Lai D, Zhu H, Roby AE, Johnson NP, Steptoe DD, Patel MB, Kirkeeide R, Gould KL. Optimal Adenosine Stress for Maximum Stress Perfusion, Coronary Flow Reserve, and Pixel Distribution of Coronary Flow Capacity by Kolmogorov-Smirnov Analysis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005650. [PMID: 28213449 DOI: 10.1161/circimaging.116.005650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/09/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Different adenosine stress imaging protocols have not been systemically validated for absolute myocardial perfusion and coronary flow reserve (CFR) by positron emission tomography, where submaximal stress precludes assessing physiological severity of coronary artery disease. METHODS AND RESULTS In 127 volunteers, serial rest-stress positron emission tomography scans using rubidium-82 with various adenosine infusion protocols identified (1) the protocol with maximum stress perfusion and CFR, (2) test-retest precision in same subject, (3) stress perfusion and CFR after adenosine compared with dipyridamole, (4) heterogeneity of coronary flow capacity combining stress perfusion and CFR, and (5) potential relevance for patients with risk factors or coronary artery disease. The adenosine 6-minute infusion with rubidium-82 injection at 3 minutes caused CFR that was significantly 15.7% higher than the 4-minute adenosine infusion with rubidium-82 injection at 2 minutes and significantly more homogeneous by Kolmogorov-Smirnov analysis for histograms of 1344 pixel range of perfusion in paired positron emission tomographies. In a coronary artery disease cohort separate from volunteers of this study, compared with the 3/6-minute protocol, the 2/4-minute adenosine protocol would potentially have changed 332 of 1732 (19%) positron emission tomographies at low-risk physiological severity CFR ≥2.3 to CFR <2.0, thereby implying high-risk quantitative severity potentially appropriate for interventions but because of suboptimal stress of the 2/4 protocol in some patients. CONCLUSIONS The 6-minute adenosine infusion with rubidium-82 activation at 3 minutes produced CFR that averaged 15.7% higher than that in the 2/4-minute protocol, thereby potentially providing essential information for personalized management in some patients.
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Affiliation(s)
- Danai Kitkungvan
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Dejian Lai
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Hongjian Zhu
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Amanda E Roby
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Nils P Johnson
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Derek D Steptoe
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Monica B Patel
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - Richard Kirkeeide
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.)
| | - K Lance Gould
- From the Weatherhead PET Center For Preventing and Reversing Atherosclerosis (A.E.R., D.D.S., K.L.G.), Division of Cardiology, Department of Medicine (D.K., N.P.J., M.B.P., R.K.), McGovern Medial Medical School, University of Texas, and Memorial Hermann Hospital, Houston; and Department of Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (D.L., H.Z.).
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47
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Zimmermann FM, Pijls NHJ, De Bruyne B, Bech GJW, van Schaardenburgh P, Kirkeeide RL, Gould KL, Johnson NP. What can intracoronary pressure measurements tell us about flow reserve? Pressure-Bounded coronary flow reserve and example application to the randomized DEFER trial. Catheter Cardiovasc Interv 2017; 90:917-925. [DOI: 10.1002/ccd.26972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/16/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Nico H. J. Pijls
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
- Department of Biomedical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
| | | | | | | | - Richard L. Kirkeeide
- Weatherhead PET Center; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital; Houston Texas
| | - K. Lance Gould
- Weatherhead PET Center; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital; Houston Texas
| | - Nils P. Johnson
- Department of Cardiology; Catharina Hospital; Eindhoven The Netherlands
- Weatherhead PET Center; Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital; Houston Texas
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48
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Jimenez S, Lai D, Gould KL, Davis BR. Evaluating the effects of treatment switching with randomization as an instrumental variable in a randomized controlled trial. COMMUN STAT-SIMUL C 2017. [DOI: 10.1080/03610918.2016.1140775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sara Jimenez
- The University of Texas School of Public Health, Houston, TX, USA
| | - Dejian Lai
- The University of Texas School of Public Health, Houston, TX, USA
| | - K. Lance Gould
- The University of Texas Medical School, Houston, TX, USA
| | - Barry R. Davis
- The University of Texas School of Public Health, Houston, TX, USA
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Kobayashi Y, Johnson NP, Berry C, De Bruyne B, Gould KL, Jeremias A, Oldroyd KG, Pijls NH, Fearon WF. The Influence of Lesion Location on the Diagnostic Accuracy of Adenosine-Free Coronary Pressure Wire Measurements. JACC Cardiovasc Interv 2016; 9:2390-2399. [DOI: 10.1016/j.jcin.2016.08.041] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 01/27/2023]
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Zimmermann F, Pijls N, De Bruyne B, Bech JW, van Schaardenburgh P, Gould KL, Johnson N, Kirkeeide RL. TCT-537 What can intracoronary pressure measurements tell us about flow reserve? Pressure-bounded CFR and its application to the randomized DEFER trial. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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