Circ Cardiovasc Imaging. 2016;9(9):CIRCIMAGING.116.004768.
Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by 13N-ammonia Positron Emission Tomography.
제1저자 이주명 · 교신저자 구본권, 천기정
소속 (2)
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul National University, Korea (B.-K.K., S.-H.N.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); and Department of Cardiology, Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (J.-M.A., S.-J.P.).
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul National University, Korea (B.-K.K., S.-H.N.); Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea (K.-H.J.); and Department of Cardiology, Heart Institute, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (J.-M.A., S.-J.P.). bkkoo@snu.ac.kr larrycheon@gmail.com.
Abstract
BACKGROUND Recent evidence suggests that the diagnostic accuracy of myocardial perfusion imaging is improved by quantifying stress myocardial blood flow (MBF) in absolute terms. We evaluated a comprehensive quantitative (13)N-ammonia positron emission tomography ((13)NH3-PET) diagnostic panel, including stress MBF, coronary flow reserve (CFR), and relative flow reserve (RFR) in conjunction with relative perfusion defect (PD) assessments to better detect functionally significant coronary artery stenosis.
METHODS AND RESULTS A total of 130 patients (307 vessels) with coronary artery disease underwent both (13)NH3-PET and invasive coronary angiography with fractional flow reserve (FFR) measurement. Diagnostic accuracy, optimal cut points, and discrimination indices of respective (13)NH3-PET quantitative measures were compared, with FFR as standard reference. The capacity to discern disease with stepwise addition of stress MBF, CFR, and RFR to qualitatively assessed relative PD was also gauged, using the category-free net reclassification index. All quantitative measures showed significant correlation with FFR (PET-derived CFR, r=0.388; stress MBF, r=0.496; and RFR, r=0.780; all P<0.001). Optimal respective cut points for FFR ≤0.8 and ≤0.75 were 1.99 and 1.84 mL/min per g for stress MBF and 2.12 and 2.00 for PET-derived CFR. Discrimination indices of quantitative measures that correlated with FFR ≤0.8 were all significantly higher than that of relative PD (area under the curve: 0.626, 0.730, 0.806, and 0.897 for relative PD, CFR, stress MBF, and RFR, respectively; overall comparison P<0.001). The capacity for functionally significant coronary stenosis was incrementally improved by the successive addition of CFR (net reclassification index=0.629), stress MBF (net reclassification index=0.950), and RFR (net reclassification index=1.253; all P<0.001) to relative PD.
CONCLUSIONS Integrating quantitative (13)NH3-PET measures with qualitative myocardial perfusion assessment provides superior diagnostic accuracy and improves the capacity to detect functionally significant coronary artery stenosis.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01621438 and NCT01366404.
© 2016 American Heart Association, Inc.
Keywords
coronary artery diseasefractional flow reservemyocardial ischemiamyocardial perfusion imagingpositron emission tomography
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그 밖의 정보
- 출판 형태
- Evaluation Study, Journal Article
- 저널
- Circulation. Cardiovascular imaging · eISSN 1942-0080
- MeSH
- Aged · Ammonia / administration & dosage · Area Under Curve · Coronary Angiography · Coronary Artery Disease / diagnostic imaging / physiopathology · Coronary Stenosis / diagnostic imaging / physiopathology · Coronary Vessels / diagnostic imaging / physiopathology · Female · Fractional Flow Reserve, Myocardial* · Humans · Male · Middle Aged · Myocardial Perfusion Imaging / methods · Nitrogen Radioisotopes / administration & dosage · Positron-Emission Tomography* · Predictive Value of Tests · ROC Curve · Radiopharmaceuticals / administration & dosage · Reproducibility of Results · Republic of Korea · Severity of Illness Index
- Substances
- Nitrogen Radioisotopes · Radiopharmaceuticals · Ammonia
- 데이터
- ClinicalTrials.gov: NCT01621438, NCT01366404