Myocardial perfusion reserve compared with peripheral perfusion reserve: A 13Nammonia PET studyReport as inadecuate




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Journal of Nuclear Cardiology

, Volume 18, Issue 2, pp 238–246

First Online: 23 February 2011Received: 22 August 2010Accepted: 16 January 2011

Abstract

Introduction13Nammonia PET allows quantification of myocardial perfusion. The similarity between peripheral flow and myocardial perfusion is unclear. We compared perfusion flow in the myocardium with the upper limb during rest and adenosine stress 13Nammonia PET to establish whether peripheral perfusion reserve PPR correlates with MPR.

Methods13Nammonia myocardial perfusion PET-scans of 58 patients were evaluated 27 men, 31 women, age 64 ± 13 years and were divided in four subgroups: patients with coronary artery disease CAD, n = 15, cardiac syndrome X SX, n = 14, idiopathic dilating cardiomyopathy DCM, n = 16, and normal controls NC, n = 13. Peripheral limb perfusion was measured in the muscular tissue of the proximal upper limb and quantified through a 2-tissue-compartment model and the PPR was calculated stress-rest ratio. MPR was also calculated by a 2-tissue-compartment model. The PPR results were compared with the MPR findings.

ResultsMean myocardial perfusion increased significantly in all groups as evidenced by the MPR CAD 1.99 ± 0.47; SX 1.39 ± 0.31; DCM 1.72 ± 0.69; NC 2.91 ± 0.78. Mean peripheral perfusion also increased but not significantly and accompanied with great variations within and between groups mean PPR: CAD 1.30 ± 0.79; SX 1.36 ± 0.71; DCM 1.60 ± 1.22; NC 1.27 ± 0.63. The mean difference between PPR and MPR for all subpopulations varied widely. No significant correlations in flow reserve were found between peripheral and myocardial microcirculatory beds in any of the groups Total group: r = −0.07, SEE = 0.70, CAD: r = 0.14, SEE = 0.48, SX: r = 0.17, SEE = 0.30, DCM: r = −0.11, SEE = 0.71, NC: r = −0.19, SEE = 0.80.

ConclusionNo correlations between myocardial and peripheral perfusion reserve were found in different patient populations in the same PET session. This suggests a functional difference between peripheral and myocardial flow in the response to intravenously administered adenosine stress.

KeywordsMyocardial perfusion imaging peripheral perfusion imaging coronary flow reserve vasodilator stress N-13 ammonia See related editorial, doi:10.1007-s12350-011-9357-0

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Author: A. M. Scholtens - R. A. Tio - A. Willemsen - R. A. J. O. Dierckx - H. H. Boersma - C. J. Zeebregts - A. W. J. M. 

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