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Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

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Abstract

Purpose

The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT).

Methods

Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups.

Results

The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80 ± 0.35 vs 2.76 ± 1.13 for pLAD and mdLAD groups, respectively, p = 0.034), while global MFR was not different (2.10 ± 1.10 vs 2.34 ± 0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0 ± 11.5 % vs 21.1 ± 15.8 %, p = 0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups.

Conclusions

The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion.

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References

  1. Sabharwal NK, Lahiri A. Role of myocardial perfusion imaging for risk stratification in suspected or known coronary artery disease. Heart. 2003;89:1291–7.

    Article  PubMed  CAS  Google Scholar 

  2. Donato P, Coelho P, Santos C, Bernardes A, Caseiro-Alves F. Correspondence between left ventricular 17 myocardial segments and coronary anatomy obtained by multi-detector computed tomography: an ex vivo contribution. Surg Radiol Anat. 2012;34:805–10.

    Article  PubMed  Google Scholar 

  3. Javadi MS, Lautamaki R, Merrill J, Voicu C, Epley W, McBride G, 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;51:198–203.

    Article  PubMed  Google Scholar 

  4. Galvin JM, Brown KA. The site of acute myocardial infarction is related to the coronary territory of transient defects on prior myocardial perfusion imaging. J Nucl Cardiol. 1996;3:382–8.

    Article  PubMed  CAS  Google Scholar 

  5. Cerci RJ, Arbab-Zadeh A, George RT, Miller JM, Vavere AL, Mehra V, et al. Aligning coronary anatomy and myocardial perfusion territories: an algorithm for the CORE320 multicenter study. Circ Cardiovasc Imaging. 2012;5:587–95.

    Article  PubMed  Google Scholar 

  6. De Luca L, Bovenzi F, Rubini D, Niccoli-Asabella A, Rubini G, De Luca I. Stress-rest myocardial perfusion SPECT for functional assessment of coronary arteries with anomalous origin or course. J Nucl Med. 2004;45:532–6.

    PubMed  Google Scholar 

  7. Segall GM, Atwood JE, Botvinick EH, Dae MW, Lucas JR. Variability of normal coronary anatomy: implications for the interpretation of thallium-SPECT myocardial perfusion images in single-vessel disease. J Nucl Med. 1995;36:944–51.

    PubMed  CAS  Google Scholar 

  8. Gohlke H, Thomas H, Betz P, Roskamm H. Transmural anterior wall infarct with isolated disease of the anterior interventricular ramus. Long-term prognosis in relation to the degree of stenosis and location. Z Kardiol. 1983;72:156–62.

    PubMed  CAS  Google Scholar 

  9. Harjai KJ, Mehta RH, Stone GW, Boura JA, Grines L, Brodie BR, et al. Does proximal location of culprit lesion confer worse prognosis in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction? J Intervent Cardiol. 2006;19:285–94.

    Article  PubMed  Google Scholar 

  10. Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, 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;54:150–6.

    Article  PubMed  Google Scholar 

  11. Kaufmann PA, Camici PG. Myocardial blood flow measurement by PET: technical aspects and clinical applications. J Nucl Med. 2005;46:75–88.

    PubMed  Google Scholar 

  12. Saraste A, Kajander S, Han C, Nesterov SV, Knuuti J. PET: Is myocardial flow quantification a clinical reality? J Nucl Cardiol. 2012;19:1044–59.

    Article  PubMed  Google Scholar 

  13. Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). J Am Coll Cardiol. 1999;33:1756–824.

    Article  PubMed  CAS  Google Scholar 

  14. Henzlova MJ, Cerqueira MD, Mahmarian JJ, Yao SS. Stress protocols and tracers. J Nucl Cardiol. 2006;13:e80–90.

    Article  PubMed  Google Scholar 

  15. Lee BI, Kim KH, Kim JY, Kim SJ, Lee JS, Min JJ, et al. Correlation between Semiquantitative Myocardial Perfusion Score and Absoulte Myocardial Blood Flow in N-13 Ammonia PET. Nucl Med Mol Imaging. 2007;41:194–200.

    Google Scholar 

  16. Deseive S, Bauer RW, Lehmann R, Kettner M, Kaiser C, Korkusuz H, et al. Dual-energy computed tomography for the detection of late enhancement in reperfused chronic infarction: a comparison to magnetic resonance imaging and histopathology in a porcine model. Invest Radiol. 2011;46:450–6.

    Article  PubMed  Google Scholar 

  17. Choi Y, Huang SC, Hawkins RA, Kim JY, Kim BT, Hoh CK, et al. Quantification of myocardial blood flow using N-13-ammonia and PET: comparison of tracer models. J Nucl Med. 1999;40:1045–55.

    PubMed  CAS  Google Scholar 

  18. Yoshinaga K, Katoh C, Noriyasu K, Iwado Y, Furuyama H, Ito Y, et al. Reduction of coronary flow reserve in areas with and without ischemia on stress perfusion imaging in patients with coronary artery disease: a study using oxygen 15-labeled water PET. J Nucl Cardiol. 2003;10:275–83.

    Article  PubMed  Google Scholar 

  19. Vrublevsky AV, Boshchenko AA, Karpov RS. Simultaneous transesophageal Doppler assessment of coronary flow reserve in the left anterior descending artery and coronary sinus allows differentiation between proximal and non-proximal left anterior descending artery stenoses. Eur J Echocardiography. 2004;5:25–33.

    Article  CAS  Google Scholar 

  20. Paul JF, Wartski M, Caussin C, Sigal-Cinqualbre A, Lancelin B, Angel C, et al. Late defect on delayed contrast-enhanced multi-detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. Radiology. 2005;236:485–9.

    Article  PubMed  Google Scholar 

  21. Olmos LI, Dakik H, Gordon R, Dunn JK, Verani MS, Quinones MA, et al. Long-term prognostic value of exercise echocardiography compared with exercise 201Tl, ECG, and clinical variables in patients evaluated for coronary artery disease. Circulation. 1998;98:2679–86.

    Article  PubMed  CAS  Google Scholar 

  22. Mahmarian JJ, Pratt CM, Boyce TM, Verani MS. The variable extent of jeopardized myocardium in patients with single vessel coronary artery disease: quantification by thallium-201 single photon emission computed tomography. J Am Coll Cardiol. 1991;17:355–62.

    Article  PubMed  CAS  Google Scholar 

  23. Fung GSK, Segars WP, Lee T-S, Higuchi T, Veress AI, Gullberg GT et al. Realistic simulation of regional myocardial perfusion defects for cardiac SPECT studies. Nuclear Science Symposium Conference Record (NSS/MIC), Knoxville, TN; 2010. p. 3061–4.

  24. Schwitter J, Nanz D, Kneifel S, Bertschinger K, Buchi M, Knusel PR, et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography. Circulation. 2001;103:2230–5.

    Article  PubMed  CAS  Google Scholar 

  25. Yang X, Imai K, Saito S, Ozawa Y, Kan-matuse K. Diagnosis of occlusion site in the left anterior descending coronary artery in patients with anterior myocardial infarction: comparison of thallium-201 myocardial scintigraphy and 12-lead electrocardiography. Jpn Circ J. 1995;59:160–70.

    Article  PubMed  CAS  Google Scholar 

  26. Rodes-Cabau J, Candell-Riera J, Angel J, de Leon G, Pereztol O, Castell-Conesa J, et al. Relation of myocardial perfusion defects and nonsignificant coronary lesions by angiography with insights from intravascular ultrasound and coronary pressure measurements. Am J Cardiol. 2005;96:1621–6.

    Article  PubMed  Google Scholar 

  27. Ziadi MC, Beanlands RS. The clinical utility of assessing myocardial blood flow using positron emission tomography. J Nucl Cardiol. 2010;17:571–81.

    Article  PubMed  Google Scholar 

  28. Fiechter M, Ghadri JR, Gebhard C, Fuchs TA, Pazhenkottil AP, Nkoulou RN, et al. Diagnostic value of 13N-ammonia myocardial perfusion PET: added value of myocardial flow reserve. J Nucl Med. 2012;53:1230–4.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by a grant (A070001) from the Korea National Enterprise for Clinical Trials.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, South Korea

    Sang-Geon Cho

  2. Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea

    Ju Han Kim & Jae Young Cho

  3. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, Korea, 519-763

    Hyeon Sik Kim & Hee-Seung Bom

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  1. Sang-Geon Cho
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Correspondence to Hee-Seung Bom.

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Fig. 4

Coronary angiography of a 72-year-old man shows 70 %-stenosis of the mid-LAD (white arrow, a) and a mild stenosis of the first diagonal branch (black arrow, a). Also noted is a concomitant moderate stenosis in the mid-RCA (arrow, b). Perfusion defects involving basal anterior wall, apex, and inferior wall are noted on polar map image (c). (JPEG 50 kb)

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Cho, SG., Kim, J.H., Cho, J.Y. et al. Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT. Nucl Med Mol Imaging 47, 158–165 (2013). https://doi.org/10.1007/s13139-013-0208-6

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  • DOI: https://doi.org/10.1007/s13139-013-0208-6

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