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Quantitative relationship between coronary vasodilator reserve assessed by 82Rb PET imaging and coronary artery stenosis severity

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The relationship between myocardial blood flow (MBF) and stenosis severity has been determined previously using cyclotron-produced radiotracers such as 15O-H2O and 13N-ammonia. An attractive alternative to overcome the limitations related to the use of cyclotron might be to use the generator-produced 82Rb as a flow tracer. The current study was undertaken to investigate the relationship between MBF and coronary vasodilator reserve (CVR) as measured by 82Rb positron emission tomography (PET) and the percent diameter stenosis as defined by quantitative coronary arteriography.

Methods

We prospectively evaluated 22 individuals: 15 patients (60 ± 11 years of age) with angiographically documented coronary artery disease (CAD) and seven age-matched (56 ± 9 years) asymptomatic individuals without risk factors for CAD. Dynamic 82Rb PET was performed at rest and after dipyridamole vasodilation. MBF, CVR and an index of ‘minimal coronary resistance’ (MCR) were assessed in each of the three main coronary territories.

Results

Rest and stress MBF in regions subtended by vessels with less than 50% diameter stenosis was similar to that of the individuals with no risk factors for CAD. As a result, CVR was also similar in the two groups (1.9, interquartile [IQ] range from 1.7 to 2.7 vs. 2.2, IQ range from 2 to 3.4 respectively, p = 0.09). CVR successfully differentiated coronary lesions with stenosis severity 70% to 89% from those with 50% to 69% stenosis (1, IQ range from 1 to 1.3 vs. 1.7, IQ range from 1.4 to 2), respectively, p = 0.001. In addition, hyperaemic MBF (r 2 = 0.74, p < 0.001), CVR (r 2 = 0.69, p < 0.001) and MCR (r 2 = 0.78, p < 0.001) measurements were inversely and non-linearly correlated to the percent diameter stenosis on angiography.

Conclusion

MBF and CVR are inversely and non-linearly correlated to stenosis severity. Quantitative 82Rb PET can be a clinically useful tool for an accurate functional assessment of CAD.

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Acknowledgements

We thank Martha Coughlan and Lisa Cantagallo, research coordinators, and also Jon Hainer, IT consultant in the Nuclear Medicine/PET division, Department of Radiology, Brigham and Women’s Hospital, for their assistance during this project.

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Authors and Affiliations

  1. Division of Nuclear Medicine/PET, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Constantinos Anagnostopoulos, Georges El Fakhri, Zelmira Curillova, Arkadiusz Sitek, Sharmila Dorbala & Marcelo F. Di Carli

  2. Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Zelmira Curillova, Sharmila Dorbala & Marcelo F. Di Carli

  3. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Alexandra Almonacid, Zelmira Curillova, Sharmila Dorbala, Jeffrey J. Popma & Marcelo F. Di Carli

  4. Department of Nuclear Medicine, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Constantinos Anagnostopoulos

  5. Department of Cardiology, Royal Brompton Hospital, London, UK

    Michael Roughton

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  1. Constantinos Anagnostopoulos
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  2. Alexandra Almonacid
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  9. Marcelo F. Di Carli
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Correspondence to Constantinos Anagnostopoulos.

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Anagnostopoulos, C., Almonacid, A., El Fakhri, G. et al. Quantitative relationship between coronary vasodilator reserve assessed by 82Rb PET imaging and coronary artery stenosis severity. Eur J Nucl Med Mol Imaging 35, 1593–1601 (2008). https://doi.org/10.1007/s00259-008-0793-2

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  • DOI: https://doi.org/10.1007/s00259-008-0793-2

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