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Impact of hemoglobin concentration on quantitative cardiac perfusion measurements
Patrik Svanström1, Tanja Kero1, Christian L Polte2
1Molecular Imaging and Medical Physics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Hemoglobin concentration impacts resting myocardial blood flow but not stress myocardial blood flow. Stress myocardial blood flow is a more reliable measure of coronary flow capacity, especially in anemic patients.
Area of Science:
- Cardiology
- Nuclear Medicine
- Physiology
Background:
- Anemia is a known prognostic factor in chronic coronary syndromes (CCS).
- The specific impact of anemia on quantitative myocardial perfusion and potential sex differences is not well understood.
- Investigating the relationship between hemoglobin concentration and myocardial blood flow (MBF) is crucial for understanding CCS.
Purpose of the Study:
- To determine if hemoglobin concentration (Hb) independently influences resting and stress myocardial blood flow (MBF) and myocardial flow reserve (MFR).
- To explore potential sex differences in the relationship between Hb and MBF parameters.
- To assess the reliability of MFR in anemic patients with CCS.
Main Methods:
- Retrospective analysis of 675 patients with suspected or known CCS undergoing cardiac 15O-water positron emission tomography (PET).
- Collected data included Hb levels, resting and stress MBF, MFR, and forward stroke volume index (FSVi).
- Utilized multivariable regression and mediation analyses to evaluate the independent effect of Hb on MBF.
Main Results:
- Hemoglobin, heart rate, FSVi, sex, and SBP explained 66% of the variation in resting MBF.
- The association between Hb and resting MBF was primarily direct, with partial mediation by FSVi in females.
- Hb was not significantly associated with stress MBF in either sex; anemia was linked to lower MFR despite normal stress MBF.
Conclusions:
- Hemoglobin concentration directly affects resting MBF but not stress MBF.
- Stress MBF appears to be a more robust measure of maximal coronary flow capacity than MFR, particularly in anemic individuals.
- These findings highlight the importance of considering Hb levels when interpreting myocardial perfusion imaging in CCS patients.
Background:
Anemia is a prognostic factor in chronic coronary syndromes (CCS), but its impact on quantitative myocardial perfusion and potential sex differences remains unclear. We investigated whether hemoglobin concentration (Hb) independently affects resting and stress myocardial blood flow (MBF) or myocardial flow reserve (MFR).
Methods:
This retrospective study included patients with known or clinically suspected CCS who underwent cardiac 15O-water positron emission tomography (PET) and had available Hb data. PET parameters included resting and stress MBF, MFR, and forward stroke volume index (FSVi), calculated by dividing cardiac index derived from the indicator dilution technique by heart rate. Multivariable regression and mediation analyses were performed to determine the independent influence of Hb.
Results:
We included 675 consecutive patients (45% female, age 66 ± 11 years, Hb 139 ± 14 g/L, 13% anemic). Heart rate, FSVi, Hb, sex, and systolic blood pressure (SBP) explained two-thirds of the variation in resting MBF (adjusted R2 = .66). In mediation analysis, the association between Hb and resting MBF was mainly direct, with partial mediation by FSVi only in females, and no mediation by heart rate or SBP. Hb was not associated with stress MBF in any sex (P ≥ .17). Anemia was associated with a higher proportion of low MFR (<2.5) despite normal stress MBF (20.9% vs. 9.3%, P = .004).
Conclusions:
Hemoglobin concentration affects resting myocardial blood flow but not stress MBF, indicating stress MBF may serve as a more robust and reliable measure of maximal coronary flow capacity than MFR, particularly in patients with anemia.
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