Diagnostic value of longitudinal flow gradient for the presence of haemodynamically significant coronary artery

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Michiel J Bom1, Roel S Driessen1, Pieter G Raijmakers2

  • 1Department of Cardiology, VU University Medical Center, De Boelelaan 1118, HZ Amsterdam, The Netherlands.

European Heart Journal. Cardiovascular Imaging
|September 14, 2018
PubMed

Insights

The longitudinal myocardial blood flow (MBF) gradient from positron emission tomography (PET) is not a reliable indicator for diagnosing significant coronary artery disease (CAD). Hyperaemic MBF showed better diagnostic value than the longitudinal MBF gradient.

Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) diagnosis relies on assessing haemodynamic significance.
  • Positison emission tomography (PET) derived longitudinal myocardial blood flow (MBF) gradient is a proposed non-invasive index for CAD.
  • The diagnostic accuracy of this gradient needs further investigation.

Purpose of the Study:

  • To evaluate the diagnostic performance of the longitudinal MBF gradient in identifying haemodynamically significant CAD.
  • To compare the diagnostic value of longitudinal MBF gradient with hyperaemic MBF.
  • To explore the influence of lesion location on the correlation between longitudinal MBF gradient and fractional flow reserve (FFR).

Main Methods:

  • 204 patients with suspected CAD underwent [15O]H2O PET and invasive coronary angiography with FFR.
  • Longitudinal base-to-apex MBF gradients were calculated using two methods based on myocardial segments.
  • Correlation and diagnostic value of longitudinal MBF gradients and hyperaemic MBF were assessed against FFR ≤ 0.80.

Main Results:

  • Longitudinal MBF gradients showed weak correlation with FFR (r=0.12-0.22).
  • Diagnostic value of longitudinal MBF gradients was lower compared to hyperaemic MBF for significant CAD.
  • Correlation between longitudinal MBF gradients and FFR was absent in proximal lesions but significant in non-proximal lesions (r=0.57).

Conclusions:

  • PET-derived longitudinal MBF gradients have limited diagnostic value for haemodynamically significant CAD compared to hyperaemic MBF.
  • Lesion location influences the correlation between longitudinal flow parameters and FFR, suggesting normalization to normally perfused areas may contribute to the gradient.
  • Further research is needed to understand the role of longitudinal flow gradients in CAD assessment.
Abstract

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