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Discordance between invasive coronary flow reserve (CFR) and non-invasive myocardial flow reserve (MFR) in diffuse

Mohammed Khalil1, Deniz Alibazoglu1, Cem Numan Balci2

  • 1Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.

BJR Case Reports
|October 8, 2020
PubMed

Insights

Quantitative positron emission tomography (PET) myocardial perfusion imaging (MPI) shows augmented stress myocardial blood flow and flow reserve in diffuse coronary ectasia. This case highlights PET-MPI

Area of Science:

  • Cardiovascular Imaging
  • Nuclear Cardiology
  • Quantitative Myocardial Perfusion

Background:

  • Quantitative positron emission tomography (PET) myocardial perfusion imaging (MPI) has growing clinical utility for diagnosing and prognosticating coronary artery disease.
  • Absolute quantification of myocardial blood flow (MBF) and myocardial flow reserve (MFR) provides valuable hemodynamic information.

Observation:

  • This case report details the first instance of augmented stress MBF and MFR in three-vessel diffuse coronary ectasia using N13-Ammonia PET MPI.
  • Qualitative MPI revealed moderate ischemia in the right coronary artery territory due to chronic total occlusion.

Findings:

  • Despite regional ischemia and chronic total occlusion, quantitative PET-MPI demonstrated augmented absolute stress MBF and MFR.
  • Regional MFR remained above ischemic thresholds, and regional stress MBF was only mildly reduced.

Implications:

  • This case suggests that quantitative PET-MPI can reveal augmented flow parameters even in complex coronary artery disease like diffuse ectasia with chronic total occlusion.
  • Absolute flow quantification may offer a more nuanced understanding of myocardial perfusion in challenging coronary pathologies.

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