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Absolute flow or myocardial flow reserve for the detection of significant coronary artery disease?
Esa Joutsiniemi1, Antti Saraste2, Mikko Pietilä1
1Heart Center, Turku University Hospital, Turku, Finland.
Insights
Absolute stress myocardial blood flow (MBF) is more accurate than myocardial flow reserve for detecting coronary artery disease (CAD). This finding allows for shorter, lower-radiation imaging protocols for CAD diagnosis.
Area of Science:
- Cardiovascular imaging
- Nuclear cardiology
- Coronary artery disease assessment
Background:
- Myocardial flow reserve (MFR) is standard for detecting coronary artery disease (CAD).
- The sufficiency of absolute stress myocardial blood flow (MBF) alone for CAD detection is unclear.
Purpose of the Study:
- To compare the diagnostic accuracy of MFR versus absolute stress MBF for detecting significant CAD.
- To evaluate the utility of absolute stress MBF as a standalone metric.
Main Methods:
- 104 patients with moderate pre-test CAD likelihood underwent positron emission tomography with O-15-water.
- Rest and adenosine stress MBF were measured in major coronary artery territories.
- Invasive coronary angiography and fractional flow reserve were used for gold-standard comparison.
Main Results:
- Absolute stress MBF (AUC 0.94) was superior to MFR (AUC 0.90) in detecting significant CAD.
- Absolute stress MBF showed higher sensitivity (95%) and NPV (98%) compared to MFR.
- An absolute increase in MBF from rest to stress also demonstrated high accuracy (AUC 0.95).
Conclusions:
- Absolute stress MBF is superior to MFR for diagnosing hemodynamically significant CAD.
- Utilizing absolute stress MBF enables shorter imaging times and reduced radiation exposure.
- This approach offers a more efficient and effective method for CAD detection.
Objectives:
We compared the accuracy of quantified myocardial flow reserve and absolute stress myocardial blood flow (MBF) alone in the detection of coronary artery disease (CAD).
Background:
Myocardial flow reserve, i.e. ratio of stress and rest flow, has been commonly used to detect CAD with many imaging modalities. However, it is not known whether absolute stress flow alone is sufficient for detection of significant CAD.
Methods:
We enrolled 104 patients with moderate (30-70%) pre-test likelihood of CAD without previous myocardial infarction. MBF was measured by positron emission tomography and O-15-water at rest and during the adenosine stress in the regions of the left anterior descending, left circumflex, and right coronary artery. All the patients underwent invasive coronary angiography including the measurement of fractional flow reserve when appropriate.
Results:
Quantified myocardial flow reserve (optimal cut-off value 2.5) detected significant coronary stenosis with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 81, 87, 66 and 94%, respectively. When compared with flow reserve, absolute MBF at stress (optimal cut-off value of 2.4 mL/min/g) was more accurate in detecting significant coronary stenosis [area under the curve (AUC) 0.94 vs. 0.90, P = 0.02] with sensitivity, specificity, PPV, and NPV of 95% (P = 0.03 vs. flow reserve), 90, 73, and 98%, respectively. An absolute increase of MBF from rest to stress by <1.5 mL/g/min had also similar accuracy in detecting CAD (AUC: 0.95). The results were comparable in patients who did and did not receive i.v. beta-blockers prior imaging.
Conclusions:
Absolute stress perfusion alone was superior to perfusion reserve in the detection of haemodynamically significant CAD and allows shorter imaging protocols with smaller radiation dose.
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