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Estimation of Microvascular Dysfunction by Using 13N-Ammonia Positron Emission Tomography with Quantitative
Shogo Imai1, Tomonari Kiriyama1, Koji Kanaya2
1Department of Radiology, Nippon Medical School.
Insights
Assessing microvascular dysfunction in coronary artery disease (CAD) is crucial. Hyperemic myocardial blood flow (MBF) in normal-perfusion areas, measured with 13N-ammonia PET-MPI, can estimate microvascular disease severity in CAD patients.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Coronary artery disease (CAD) involves both epicardial atherosclerosis and microvascular dysfunction.
- Microvascular dysfunction's clinical significance is often underestimated.
- Assessing microvascular resistance (MVR) using myocardial blood flow (MBF) is key.
Purpose of the Study:
- To evaluate microvascular disease severity in CAD patients.
- To utilize 13N-ammonia positron emission tomography-myocardial perfusion imaging (PET-MPI) for assessing hyperemic microvascular resistance (MVR).
- To correlate MVR with myocardial blood flow (MBF) measurements.
Main Methods:
- Retrospective analysis of 23 CAD patients with PET-MPI and invasive coronary angiography (CAG).
- Fractional flow reserve (FFR) measurements were used to identify stenotic vessels (FFR ≤0.75).
- Hyperemic MVR calculated using pressure, FFR, and hyperemic MBF in stenotic and reference areas.
Main Results:
- A significant negative correlation (R = -0.758, P<0.001) was found between hyperemic MVR and hyperemic MBF in normal-perfusion areas.
- This suggests hyperemic MBF in non-diseased areas reflects microvascular function.
Conclusions:
- Microvascular disease severity in chronic CAD can be estimated non-invasively.
- 13N-ammonia PET-MPI provides a method to assess hyperemic MBF in normal-perfusion areas.
- This approach aids in understanding and managing microvascular dysfunction in CAD.
Background:
Although coronary artery disease (CAD) is characterized by epicardial atherosclerosis and microvascular disease, the importance of evaluating microvascular dysfunction has not been sufficiently recognized in clinical practice. We estimated microvascular disease severity by assessing hyperemic microvascular resistance (MVR), as determined by absolute quantification of myocardial blood flow (MBF) with 13N-ammonia positron emission tomography-myocardial perfusion imaging (PET-MPI).
Methods:
We retrospectively collected data for 23 CAD patients who underwent both stress/rest PET-MPI and invasive coronary angiography (CAG) with fractional flow reserve (FFR) measurement. Among 30 vessels for which FFR measurement was performed, 13 had a low FFR (FFR ≤0.75). For each patient, myocardial segments of a standard 17-segment model were assigned to the stenotic myocardial area perfused by the FFR-measured vessel and a reference normal-perfusion area based on PET-MPI and the coronary distribution on CAG. Hyperemic MVR was calculated by using the formula, hyperemic MVR = hyperemic mean blood pressure × FFR/hyperemic MBF of the stenotic vessel.
Results:
A strong negative correlation was observed between hyperemic MVR and hyperemic MBF in the reference normal-perfusion area (R = -0.758, P<0.001).
Conclusion:
Microvascular disease severity in chronic CAD can be estimated by hyperemic MBF of the normal-perfusion area with 13N-ammonia PET-MPI.
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