AccScience Publishing / ARNM / Volume 2 / Issue 3 / DOI: 10.36922/arnm.3786
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ORIGINAL RESEARCH ARTICLE

Association between 82Rb positron emission tomography-derived regional myocardial blood flow, severity of angiographic coronary artery stenosis, and mortality in patients with chest pain

Cesia Gallegos1* ,  Camila Trejo Paredes1† ,  Jiun-Ruey Hu1† ,  Edith L. Posada2 ,  Yuichi Saito3 ,  Alexandra Lansky1 ,  Samit Shah1 ,  Yi-Hwa Liu1 ,  Kim G. Smolderen1,4 ,  Carlos Mena-Hurtado1 ,  Albert J. Sinusas1 ,  Edward J. Miller1
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1 Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
2 Department of Cardiology, National Institute of Cardiology Ignacio Chávez City, Mexico
3 Department of Cardiology, School of Medicine, Teikyo University, Tokyo, Japan
4 Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
ARNM 2024, 2(3), 3786 https://doi.org/10.36922/arnm.3786
Submitted: 29 May 2024 | Accepted: 27 July 2024 | Published: 23 September 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Impairment in global myocardial flow reserve (MFR) on rubidium-82 (82Rb) positron emission tomography (PET) stress testing predicts cardiovascular events; however, the relationship between regional coronary artery territory myocardial blood flow (MBF) and invasive coronary angiography is unknown. In this study, patients with acute chest pain who were referred for coronary angiography after abnormal PET stress testing were evaluated. Both global and regional coronary territory stress and rest MBF were derived using 82Rb PET. Coronary artery stenosis severity was assessed using quantitative coronary angiography (QCA) performed within 3 months of PET. A total of 189 patients were followed for a median of 4.1 years. The results showed a weak correlation between regional MFR impairment (<1.7) and stenosis severity in the left descending artery (r = −0.20, P = 0.005), left circumflex artery (r = −0.15, P = 0.042), and right coronary artery (r = −0.26, P < 0.001). In addition, a weak correlation was observed between global MFR and stenosis in any vessel, in both binary and continuous analyses. However, impairment in MFR within any territory was associated with increased all-cause mortality in both unadjusted and adjusted analyses. In conclusion, this is the first large-scale study to examine the relationship between regional coronary territory MBF, coronary artery stenosis severity as assessed using QCA, and mortality. Although coronary territory MFR demonstrated a weak correlation with coronary stenosis severity, impairment in per-territory MFR was significantly associated with increased all-cause mortality, suggesting that mechanisms such as diffuse atherosclerosis and/or microvascular disease may be contributing factors.

Keywords
Myocardial blood flow
Myocardial flow reserve
Positron emission tomography
Perfusion
Coronary microvascular disease
Funding
None.
Conflict of interest
Kim G. Smolderen is a consultant for Happify, Hook, and UnitedHealthcare. Carlos Mena Hurtado is a consultant for Cook and Abbott. Edward J. Miller is a consultant for Alnylam, Pfizer, GE, and CSL Behring. The other authors have no conflicts of interest to declare.
References
  1. Murthy VL, Bateman TM, Beanlands RS, et al. Clinical quantification of myocardial blood flow using PET: Joint position paper of the SNMMI Cardiovascular council and the ASNC. J Nucl Med. 2018;59(2):273-293. doi: 10.2967/jnumed.117.201368

 

  1. Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/ computed tomography in the detection of coronary artery disease. J Am Coll Cardiol. 2007;49(10):1052-1058. doi: 10.1016/j.jacc.2006.12.015

 

  1. Parker MW, Iskandar A, Limone B, et al. Diagnostic accuracy of cardiac positron emission tomography versus single photon emission computed tomography for coronary artery disease: A bivariate meta-analysis. Circ Cardiovasc Imaging. 2012;5(6):700-707. doi: 10.1161/circimaging.112.978270

 

  1. Lee JM, Kim CH, Koo BK, et al. Integrated myocardial perfusion imaging diagnostics improve detection of functionally significant coronary artery stenosis by 13N-ammonia positron emission tomography. Circ Cardiovasc Imaging. 2016;9(9):e004768. doi: 10.1161/circimaging.116.004768

 

  1. Valenta I, Quercioli A, Schindler TH. Diagnostic value of PET-measured longitudinal flow gradient for the identification of coronary artery disease. JACC Cardiovasc Imaging. 2014;7(4):387-396. doi: 10.1016/j.jcmg.2014.01.001

 

  1. Joutsiniemi E, Saraste A, Pietilä M, et al. Absolute flow or myocardial flow reserve for the detection of significant coronary artery disease? Eur Heart J Cardiovasc Imaging. 2014;15(6):659-665. doi: 10.1093/ehjci/jet274

 

  1. Hajjiri MM, Leavitt MB, Zheng H, Spooner AE, Fischman AJ, Gewirtz H. Comparison of positron emission tomography measurement of adenosine-stimulated absolute myocardial blood flow versus relative myocardial tracer content for physiological assessment of coronary artery stenosis severity and location. JACC Cardiovasc Imaging. 2009;2(6):751-758. doi: 10.1016/j.jcmg.2009.04.004

 

  1. Fiechter M, Ghadri JR, Gebhard C, et al. Diagnostic value of N-13 ammonia myocardial perfusion PET: Added value of myocardial flow reserve. J Nucl Med. 2012;53(8):1230-1234. doi: 10.2967/jnumed.111.101840

 

  1. Ziadi MC, DeKemp RA, Williams K, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? journal article. J Nucl Cardiol. 2012;19(4):670–680. doi: 10.1007/s12350-011-9506-5

 

  1. Schindler TH, Fearon WF, Pelletier-Galarneau M, et al. Myocardial perfusion PET for the detection and reporting of coronary microvascular dysfunction: A JACC: cardiovascular imaging expert panel statement. JACC Cardiovasc Imaging. 2023;16:536-548. doi: 10.1016/j.jcmg.2022.12.015

 

  1. Parkash R, Ruddy T, Kitsikis A, Hart R, Beauschene L, Williams K. Potential utility of rubidium 82 PET quantification in patients with 3-vessel coronary artery disease. J Nucl Cardiol. 2004;11:440-449. doi: 10.1016/j.nuclcard.2004.04.005

 

  1. Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124(20):2215-2224. doi: 10.1161/CIRCULATIONAHA.111.050427

 

  1. Ziadi MC, Dekemp RA, Williams KA, et al. Impaired myocardial flow reserve on rubidium-82 positron emission tomography imaging predicts adverse outcomes in patients assessed for myocardial ischemia. J Am Coll Cardiol. 2011;58(7):740-748. doi: 10.1016/j.jacc.2011.01.065

 

  1. Herzog BA, Husmann L, Valenta I, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol. 2009;54(2):150-156. doi: 10.1016/j.jacc.2009.02.069

 

  1. Murthy VL, Naya M, Foster CR, et al. Coronary vascular dysfunction and prognosis in patients with chronic kidney disease. JACC Cardiovasc Imaging. 2012;5(10):1025-1034. doi: 10.1016/j.jcmg.2012.06.007

 

  1. Murthy VL, Bateman TM, Beanlands RS, et al. Clinical quantification of myocardial blood flow using PET: Joint position paper of the SNMMI cardiovascular council and the ASNC. J Nucl Cardiol. 2018;25(1):269-297. doi: 10.1007/s12350-017-1110-x

 

  1. Feher A, Srivastava A, Quail MA, et al. Serial assessment of coronary flow reserve by rubidium-82 positron emission tomography predicts mortality in heart transplant recipients. JACC Cardiovasc Imaging. 2020;13(1_Part_1):109-120. doi: 10.1016/j.jcmg.2018.08.025

 

  1. Meijboom WB, Van Mieghem Carlos AG, Van Pelt N, et al. Comprehensive assessment of coronary artery stenoses. Computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol. 2008;52(8):636-643. doi: 10.1016/j.jacc.2008.05.024

 

  1. Di Carli M, Czernin J, Hoh Carl K, et al. Relation among stenosis severity, myocardial blood flow, and flow reserve in patients with coronary artery disease. Circulation. 1995;91(7):1944-1951. doi: 10.1161/01.CIR.91.7.1944

 

  1. Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med. 1994;330(25):1782-1788. doi: 10.1056/NEJM199406233302503

 

  1. Gould KL, Nakagawa Y, Nakagawa K, et al. Frequency and clinical implications of fluid dynamically significant diffuse coronary artery disease manifest as graded, longitudinal, base-to-apex myocardial perfusion abnormalities by noninvasive positron emission tomography. Circulation. 2000;101(16):1931-1939. doi: 10.1161/01.cir.101.16.1931

 

  1. Goldstein RA, Kirkeeide RL, Demer LL, et al. Relation between geometric dimensions of coronary artery stenoses and myocardial perfusion reserve in man. J Clin Invest. 1987;79(5):1473-1478. doi: 10.1172/jci112976

 

  1. Kirkeeide RL, Gould KL, Parsel L. Assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation. VII. Validation of coronary flow reserve as a single integrated functional measure of stenosis severity reflecting all its geometric dimensions. J Am Coll Cardiol. 1986;7(1):103-113. doi: 10.1016/s0735-1097(86)80266-2

 

  1. Naya M, Murthy VL, Taqueti VR, et al. Preserved coronary flow reserve effectively excludes high-risk coronary artery disease on angiography. J Nucl Med. 2014;55(2):248-255. doi: 10.2967/jnumed.113.121442

 

  1. Javadi MS, Lautamäki R, Merrill J, et al. Definition of vascular territories on myocardial perfusion images by integration with true coronary anatomy: A hybrid PET/CT analysis. J Nucl Med. 2010;51(2):198-203. doi: 10.2967/jnumed.109.067488

 

  1. Fukushima K, Javadi MS, Higuchi T, et al. Prediction of short-term cardiovascular events using quantification of global myocardial flow reserve in patients referred for clinical 82Rb PET perfusion imaging. J Nucl Med. 2011;52(5):726-732. doi: 10.2967/jnumed.110.081828

 

  1. Panza JA. Myocardial ischemia and the pains of the heart. N Engl J Med. 2002;346(25):1934-1935. doi: 10.1056/NEJMp020047
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Published by AccScience Publishing
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